Associations of Lipoprotein(a) With Coronary Atherosclerotic Burden and All-Cause Mortality in Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

Abstract

Background: The coronary atherosclerotic burden in patients with ST-segment elevation myocardial infarction (STEMI) has been identified as the main predictor of prognosis. However, the association of lipoprotein(a) [Lp(a)], a well-established proatherogenic factor, with atherosclerotic burden in patients with STEMI is unclear.Methods: In total, 1,359 patients who underwent percutaneous coronary intervention (PCI) for STEMI were included in analyses. Three prespecified models with adjustment for demographic parameters and risk factors were evaluated. Generalized additive models and restricted cubic spline analyses were used to assess the relationships of Lp(a) with Gensini scores and the no-reflow phenomenon. Kaplan–Meier curves were generated to explore the predictive value of Lp(a) for long-term all-cause mortality. Furthermore, mRNA expression levels of LPA in different groups were compared using the GEO database.Results: Patients in the highest tertile according to Lp(a) levels had an increased incidence of heart failure during hospitalization. Furthermore, patients with high levels of Lp(a) (>19.1 mg/dL) had sharply increased risks for a higher Gensini score (Pfor trend = 0.03) and no-reflow (Pfor trend = 0.002) after adjustment for demographic parameters and risk factors. During a median follow-up of 930 days, 132 deaths (9.95%) were registered. Patients with high levels of Lp(a) (>19.1 mg/dL) had the worst long-term prognosis (Pfor trend < 0.0001). In a subgroup analysis, patients with higher Lp(a) still had the highest all-cause mortality. Additionally, the mRNA expression levels of LPA in patients with STEMI with lower cardiac function were higher than those in other groups (P = 0.003). A higher coronary atherosclerotic burden was correlated with higher LPA expression (P = 0.01).Conclusion: This study provides the first evidence that Lp(a) (at both the protein and mRNA levels) is independently associated with coronary atherosclerotic lesions and prognosis in patients with STEMI treated with PCI.Clinical Trial Registration:http://www.chictr.org.cn/index.aspx, identifier: ChiCTR1900028516.

Prolonged dual antiplatelet therapy in invasively treated acute coronary syndrome patients with different lipoprotein(a) concentrations

“…Over the last 10 years, genetic and epidemiologic evidence supported that high Lp(a) level was a risk factor for cardiovascular disease [ 3 – 6 ]. Moreover, previous studies, including the present authors, revealed that Lp(a) was positively associated with recurrent cardiovascular events in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) [ 7 – 10 ]. However, there are no approved pharmacologic therapies that are specifically aimed at lowering Lp(a) levels.…”

Prognostic value of elevated lipoprotein (a) in patients with acute coronary syndromes: a systematic review and meta-analysis

“…Ultimately, 18 full-text articles, encompassing a total of 18,168 patients (13,843 male, 4,325 female), were selected for the comprehensive pooled analysis ( 20 – 23 , 25 – 28 , 33 – 42 ). Of these articles, 5 were prospective cohort studies ( 21 , 23 , 34 , 35 , 40 ), 10 were retrospective cohort studies ( 20 , 22 , 25 , 26 , 28 , 33 , 36 – 39 ), and 3 were observational cohorts ( 4 , 27 , 41 ). The encompassed investigations in this analysis spanned the period from 2009 to 2023.…”

“…Seven studies ( 22 , 23 , 25 , 27 , 33 , 34 , 40 ) were included in the analysis to investigate the relationship between elevated Lp (a) levels and the risk of all-cause mortality ( Figure 3A ). Utilizing a random-effects model, the pooled Hazard Ratio (HR) for all-cause mortality was 1.36 (95% CI: 1.05–1.76) when comparing high to low category of Lp (a) levels.…”

Lipoprotein(a) and Cardiovascular Disease: A Missing Link for Premature Atherosclerotic Heart Disease and/or Residual Risk

“…33 A prospective study comprising 1359 patients who were submitted to percutaneous coronary intervention (PCI) for STEMI showed that patients in the upper tertile of Lp(a) concentrations had a high occurrence of HF during hospitalization. 34 Also, patients with high concentrations of Lp(a) (>19.1 mg/dL) had higher risks for a greater Gensini score ( P for trend = 0.03) of CAD severity, and no reflow ( P for trend = 0.002) after adjusting for demographic features and risk factors. Over a median of 2.5 years, 132 deaths (9.95%) were recorded.…”