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Prognostic Value of Serum Lipoprotein(a) Levels in Japanese Patients With ST-Segment Elevation Myocardial Infarction
Keiko Nishiyama1, Kensaku Nishihira1, Michikazu Nakai2
1Department of Cardiology, Miyazaki Medical Association Hospital.
Insights
Elevated lipoprotein(a) [Lp(a)] levels predict worse long-term outcomes in Japanese patients with ST-segment elevation myocardial infarction (STEMI). Higher Lp(a) is linked to increased cardiovascular events and revascularization needs.
Area of Science:
- Cardiology
- Clinical Biochemistry
- Epidemiology
Background:
- The prognostic significance of lipoprotein(a) [Lp(a)] in Japanese ST-segment elevation myocardial infarction (STEMI) patients is not well-established.
- Assessing Lp(a) distribution and its association with long-term outcomes is crucial for risk stratification.
Purpose of the Study:
- To investigate the distribution of lipoprotein(a) [Lp(a)] levels in Japanese patients with STEMI.
- To determine the association between elevated Lp(a) and long-term cardiovascular outcomes in this population.
Main Methods:
- Retrospective analysis of 868 consecutive STEMI patients.
- Stratification into high (≥47.26 mg/dL) and low (<47.26 mg/dL) Lp(a) groups using restricted cubic spline analysis.
- Multivariable adjustment for confounders to identify independent predictors.
Main Results:
- Median Lp(a) level was 15.75 mg/dL; median follow-up was 736.5 days.
- The high Lp(a) group exhibited distinct demographic and clinical characteristics, including higher dyslipidemia prevalence.
- A significantly higher 5-year cumulative incidence of the composite endpoint (cardiovascular death, MI, stroke, revascularization) was observed in the high Lp(a) group, driven by revascularization rates.
- Elevated Lp(a) independently predicted the primary endpoint (HR: 1.932; 95% CI: 1.255-2.974).
Conclusions:
- Elevated lipoprotein(a) levels are independently associated with adverse long-term outcomes in Japanese patients with STEMI.
- Lipoprotein(a) may serve as a valuable prognostic biomarker in this patient cohort, particularly for predicting revascularization needs.
Background:
Because the prognostic value of lipoprotein(a) [Lp(a)] levels in Japanese patients remains unclear, we assessed their distribution and association with long-term outcomes in ST-segment elevation myocardial infarction (STEMI).
Methods And Results:
In our retrospective analysis of 868 consecutive patients with STEMI, the median serum Lp(a) level was 15.75 mg/dL at admission, and the median follow-up was 736.5 days. Using restricted cubic spline analysis, we stratified patients into high (≥47.26 mg/dL) and low (<47.26 mg/dL) Lp(a) groups. The high Lp(a) group had a higher proportion of older and female patients, with lower body weight, estimated glomerular filtration rate, and stent use, and higher dyslipidemia prevalence than those in the low Lp(a) group. The 5-year cumulative incidence of the composite primary endpoint (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or any revascularization) was significantly higher in the high Lp(a) group, primarily because of a high rate of any revascularization. Patients with elevated Lp(a) levels demonstrated higher rates of any revascularization for both de novo and restenotic lesions than those with lower levels. After adjusting for confounders, a high Lp(a) level was identified as an independent predictor of the primary endpoint (hazard ratio:1.932; 95% confidence interval:1.255-2.974).
Conclusions:
In Japanese patients with STEMI, elevated Lp(a) levels were independently associated with worse long-term outcomes.
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