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Admission lipoprotein-associated phospholipase A2 activity is not associated with long-term clinical outcomes after
Pier Woudstra1, Peter Damman1, Wichert J Kuijt1
1Heart Center, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
Insights
Lipoprotein-associated phospholipase A2 (Lp-PLA2) activity does not predict cardiovascular outcomes in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). Further research is needed to establish Lp-PLA2 as a reliable biomarker for STEMI risk stratification.
Area of Science:
- Cardiology
- Biomarkers
- Interventional Cardiology
Background:
- Lipoprotein-associated phospholipase A2 (Lp-PLA2) activity is a known predictor of cardiovascular diseases.
- Its prognostic value in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI) remains unclear.
Purpose of the Study:
- To investigate the association between Lp-PLA2 activity and long-term clinical outcomes in STEMI patients treated with pPCI.
- To determine if Lp-PLA2 can serve as an independent risk stratification biomarker in this patient population.
Main Methods:
- Lp-PLA2 activity was measured in 987 STEMI patients before pPCI.
- Five-year all-cause mortality was assessed using Kaplan-Meier analysis and Cox regression.
- Clinical endpoints were evaluated in a subpopulation at three years.
Main Results:
- No significant differences in five-year mortality were observed across Lp-PLA2 activity tertiles (low, intermediate, high).
- Landmark analysis and multivariable regression, adjusting for established risk scores, also showed non-significant associations.
- Clinical endpoints in the subpopulation did not differ significantly among Lp-PLA2 tertiles.
Conclusions:
- Lp-PLA2 activity levels upon admission in STEMI patients undergoing pPCI are not associated with short or long-term clinical endpoints.
- The role of Lp-PLA2 as an independent and clinically useful biomarker for risk stratification in STEMI patients requires further investigation.
Background:
Lipoprotein-associated phospholipase A2 (Lp-PLA2) activity is a biomarker predicting cardiovascular diseases in a real-world. However, the prognostic value in patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI) on long-term clinical outcomes is unknown.
Methods:
Lp-PLA2 activity was measured in samples obtained prior to pPCI from consecutive STEMI patients in a high-volume intervention center from 2005 until 2007. Five years all-cause mortality was estimated with the Kaplan-Meier method and compared among tertiles of Lp-PLA2 activity during complete follow-up and with a landmark at 30 days. In a subpopulation clinical endpoints were assessed at three years. The prognostic value of Lp-PLA2, in addition to the Thrombolysis In Myocardial Infarction or multimarker risk score, was assessed in multivariable Cox regression.
Results:
The cohort (n = 987) was divided into tertiles (low <144, intermediate 144-179, and high >179 nmol/min/mL). Among the tertiles differences in baseline characteristics associated with long-term mortality were observed. However, no significant differences in five years mortality in association with Lp-PLA2 activity levels were found; intermediate versus low Lp-PLA2 (HR 0.97; CI 95% 0.68-1.40; p = 0.88) or high versus low Lp-PLA2 (HR 0.75; CI 95% 0.51-1.11; p = 0.15). Both in a landmark analysis and after adjustments for the established risk scores and selection of cases with biomarkers obtained, non-significant differences among the tertiles were observed. In the subpopulation no significant differences in clinical endpoints were observed among the tertiles.
Conclusion:
Lp-PLA2 activity levels at admission prior to pPCI in STEMI patients are not associated with the incidence of short and/or long-term clinical endpoints. Lp-PLA2 as an independent and clinically useful biomarker in the risk stratification of STEMI patients still remains to be proven.
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