<h4>Background</h4>Lipoprotein(a) [Lp(a)] is a potent, independent causal risk factor for coronary artery disease (CAD).<h4>Objectives</h4>This study aimed to assess the association between Lp(a) and the diagnosis, clinical presentation, and angiographic characteristics of obstructive CAD and occurrence of myocardial infarction (MI).<h4>Methods</h4>We included 446 individuals with very high Lp(a) (>230 nmol/L) who underwent routine lipid profiling, matched 2:1 by age and sex using nearest-neighbor propensity matching to 223 controls with low Lp(a) (≤7 nmol/L). Here, LPA is linked to coronary artery disorder.