Prognostic Value of Lipoprotein (a) in Japanese Patients with Acute Coronary Syndrome Surviving Primary Percutaneous Coronary Intervention to Discharge
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Published on: January 28, 2020
Ryo Okubo1, Yousuke Komatsu1, Daiki Kishigami1
1Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine.
Insights
Elevated lipoprotein(a) [Lp(a)] levels did not predict major adverse cardiac events in Japanese acute coronary syndrome patients after percutaneous coronary intervention. Traditional risk factors like age and chronic kidney disease were more significant for prognosis.
Area of Science:
- Cardiology
- Biochemistry
- Clinical Research
Background:
- Lipoprotein(a) [Lp(a)] is a potential prognostic marker in acute coronary syndrome (ACS), but previous studies show conflicting results.
- Limited data exists for Japanese populations, and early in-hospital deaths are often inconsistently included, impacting secondary prevention strategies.
Purpose of the Study:
- To assess the prognostic value of Lp(a) levels in Japanese ACS patients who survived primary percutaneous coronary intervention (PCI) and were discharged alive.
- To identify predictors of mid-term major adverse cardiac events (MACE) in this specific patient cohort.
Main Methods:
- A single-center retrospective study of 347 Japanese ACS patients undergoing primary PCI (2016-2021).
- Patients stratified by Lp(a) levels (< 30 mg/dL vs. ≥ 30 mg/dL).
- Kaplan-Meier analysis and multivariable Cox regression used to evaluate MACE (all-cause death, nonfatal MI, stroke, heart failure hospitalization) over a median 37-month follow-up.
Main Results:
- No significant difference in MACE-free survival was observed between Lp(a) groups (log-rank P = 0.46).
- Elevated Lp(a) levels (≥ 30 mg/dL) were not associated with mid-term MACE in multivariable analyses.
- Significant predictors of MACE included age ≥ 70 years, male sex, and chronic kidney disease.
Conclusions:
- Elevated Lp(a) levels do not appear to be a significant predictor of mid-term MACE in Japanese ACS patients who survive primary PCI.
- Age, male sex, and chronic kidney disease remain key determinants of prognosis in this population.
Abstract:
Previous studies investigating lipoprotein(a) [Lp(a)] as a prognostic factor in acute coronary syndrome (ACS) have yielded conflicting results, with limited data in Japanese populations. Inconsistent inclusion of early in-hospital deaths further limits clinical applicability for secondary prevention strategies.To evaluate the prognostic value of Lp(a) levels in ACS patients who underwent successful primary percutaneous coronary intervention (PCI) and survived to hospital discharge.This single-center retrospective study enrolled 347 consecutive Japanese ACS patients who underwent primary PCI between December 2016 and March 2021 and were discharged alive. Patients were stratified by Lp(a) levels: < 30 mg/dL (n = 275) and ≥ 30 mg/dL (n = 72). The primary endpoint was major adverse cardiac events (MACE), defined as all-cause death, nonfatal myocardial infarction, nonfatal stroke, and heart failure requiring hospitalization. Kaplan-Meier survival analysis and multivariable Cox regression models were performed.During a median follow-up of 37 months, 59 MACE events (17.0%) occurred. The median Lp(a) level was 14 mg/dL. Kaplan-Meier analysis showed no significant difference in MACE-free survival between groups (log-rank P = 0.46). In all multivariable analyses, Lp(a) ≥ 30 mg/dL was not associated with mid-term MACE. Significant predictors were age ≥ 70 years, male sex, and chronic kidney disease.Elevated Lp(a) levels did not significantly predict mid-term MACE in Japanese ACS patients surviving primary PCI. Traditional risk factors, including age, male sex, and chronic kidney disease, were the primary determinants of mid-term prognosis in this population.
