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Baseline Lipoprotein(a) Levels and Long-Term Cardiovascular Outcomes After Acute Myocardial Infarction
Joon Sung Park1, Kyung Hoon Cho1, Young Joon Hong2
1Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
Insights
High baseline lipoprotein(a) levels did not independently increase major adverse cardiovascular events in acute myocardial infarction patients. Further research is needed to clarify the role of lipoprotein(a) in cardiovascular disease prognosis.
Area of Science:
- Cardiology
- Clinical Research
- Biomarkers
Background:
- Lipoprotein(a) is a recognized independent risk factor for atherosclerotic cardiovascular disease.
- The long-term prognostic significance of baseline lipoprotein(a) levels in acute myocardial infarction (AMI) patients remains incompletely understood.
Purpose of the Study:
- To investigate the association between baseline lipoprotein(a) levels and 3-year major adverse cardiovascular events (MACE) in Korean patients with AMI.
- To determine if baseline lipoprotein(a) levels predict long-term clinical outcomes after AMI.
Main Methods:
- Analysis of 1,908 AMI patients from a single Korean center (November 2011 - October 2015).
- Patients stratified into three baseline lipoprotein(a) groups: <30 mg/dL, 30-49 mg/dL, and ≥50 mg/dL.
- Comparison of three-point MACE (nonfatal MI, nonfatal stroke, cardiac death) at 3 years across groups.
Main Results:
- A total of 326 (17.1%) three-point MACE occurred during follow-up (mean 1094 days).
- The highest lipoprotein(a) group (≥50 mg/dL) showed higher MACE rates than the lowest group (<30 mg/dL) in univariate analysis (23.0% vs. 15.7%, P=0.009).
- Multivariable analysis revealed no independent association between baseline lipoprotein(a) levels and MACE, irrespective of AMI type (STEMI vs. NSTEMI).
Conclusions:
- Baseline lipoprotein(a) levels were not independently associated with an increased risk of major adverse cardiovascular events at 3 years in Korean patients with acute myocardial infarction.
- Findings suggest that other factors may be more critical in predicting long-term outcomes post-AMI in this population.
Background:
Lipoprotein(a) is a known independent risk factor for atherosclerotic cardiovascular disease. However, the prognostic impact of the baseline lipoprotein(a) levels on long-term clinical outcomes among patients with acute myocardial infarction remain unclear.
Methods:
We analyzed 1,908 patients with acute myocardial infarction from November 2011 to October 2015 from a single center in Korea. They were divided into 3 groups according to their baseline lipoprotein(a) levels: groups I (< 30 mg/dL, n = 1,388), II (30-49 mg/dL, n = 263), and III (≥50 mg/dL, n = 257). Three-point major adverse cardiovascular events (a composite of nonfatal myocardial infarction, nonfatal stroke, and cardiac death) at 3 years were compared among the 3 groups.
Results:
The patients were followed for 1094.0 (interquartile range, 1,033.8-1,095.0) days, during which a total of 326 (17.1%) three-point major adverse cardiovascular events occurred. Group III had higher rates of three-point major adverse cardiovascular events compared with Group I (23.0% vs. 15.7%; log-rank P = 0.009). In the subgroup analysis, group III had higher rates of three-point major adverse cardiovascular events compared with group I in patients with non-ST-segment elevation myocardial infarction (27.0% vs. 17.1%; log-rank P = 0.006), but not in patients with ST-segment elevation myocardial infarction (14.4% vs. 13.3%; log-rank P = 0.597). However, in multivariable Cox time-to-event models, baseline lipoprotein(a) levels were not associated with an increased incidence of three-point major adverse cardiovascular events, regardless of the type of acute myocardial infarction. Sensitivity analyses in diverse subgroups showed similar findings to those of the main analysis.
Conclusion:
Baseline lipoprotein(a) levels in Korean patients with acute myocardial infarction were not independently associated with increased major adverse cardiovascular events at 3 years.
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