Korean Circ J.  2010 Oct;40(10):491-498. 10.4070/kcj.2010.40.10.491.

High Lipoprotein(a) Levels are Associated With Long-Term Adverse Outcomes in Acute Myocardial Infarction Patients in High Killip Classes

• Cho JY
• Jeong MH
• Ahn Y
• Hong YJ
• Park HW
• Yoon NS
• Yoon HJ
• Kim KH
• Kim JH
• Cho JG
• Park JC
• Kang JC

• KMID: 1826137
• DOI: http://doi.org/10.4070/kcj.2010.40.10.491

Abstract

BACKGROUND AND OBJECTIVES
An elevated concentration of lipoprotein(a) {Lp(a)} is associated with an increased prevalence and increased severity of coronary artery disease. However, the relationship between Lp(a) levels and outcomes after acute myocardial infarction (AMI) is unclear.
SUBJECTS AND METHODS
Between October 2005 and June 2007, we measured serum Lp(a) levels in 832 consecutive AMI patients (age, 62.8+/-12.4 years, 600 men) on admission. They were divided into tertiles according to their serum Lp(a) levels {Tertile 1 (n=276), Lp(a)<13.8 mg/dL; Tertile 2 (n=279), Lp(a)=13.8-30.6 mg/dL; Tertile 3 (n=277), Lp(a)>30.6 mg/dL}.
RESULTS
There were no differences in baseline clinical characteristics among Tertiles 1, 2, and 3, except for proportions of Killip class III-IV patients (5.8% vs. 10.0% vs. 18.8%, respectively, p<0.001). There were significant differences in left ventricular ejection fractions (57.3+/-11.4% vs. 55.9+/-12.3% vs. 53.1+/-13.1%, p<0.001). Among the laboratory findings, there were significant differences in total cholesterol (173.3+/-37.2 vs. 183.5+/-38.9 vs. 185.3+/-43.8 mg/dL, p=0.001), low density lipoprotein-cholesterol (111.3+/-34.3 vs. 122.9+/-34.7 vs. 123.3+/-39.4 mg/dL, p<0.001), apolipoprotein B (92.8+/-25.4 vs. 100.8+/-26.0 vs. 101.9+/-28.8 mg/dL, p<0.001), and amino-terminal pro-brain natriuretic peptide levels (1805.2+/-4343.3 vs. 2607.9+/-5216.3 vs. 3981.5+/-7689.7 pg/mL, p<0.001). After adjusting for multiple variables in the high Killip class (III-IV) subgroup, the risk estimate for major adverse cardiovascular events (MACE) at 1-year follow-up was significantly higher in Tertile 3 than in Tertiles 1 or 2 (hazard ratio 6.723, 95% confidence interval 1.037-43.593, p=0.046).
CONCLUSION
In patients in high Killip classes, high serum levels of Lp(a) were significantly associated with long-term adverse outcomes after AMI.

Keyword

Myocardial infarction; Lipoproteins; Prognosis

MeSH Terms

Apolipoproteins
Cholesterol
Coronary Artery Disease
Follow-Up Studies
Humans
Lipoprotein(a)
Lipoproteins
Myocardial Infarction
Natriuretic Peptide, Brain
Peptide Fragments
Prevalence
Prognosis
Stroke Volume
Apolipoproteins
Cholesterol
Lipoprotein(a)
Lipoproteins
Natriuretic Peptide, Brain
Peptide Fragments

Figure

• 

  Fig. 1 Distribution of serum concentrations of Lp(a) at baseline. Arrows mark the tertile boundaries. Lp(a): lipoprotein (a).

• 

  Fig. 2 Fully-adjusted time-to-clinical outcomes by baseline Lp(a) tertiles. Hazard ratios have been adjusted for age; sex; smoking; total cholesterol; low density lipoprotein-cholesterol; high-sensitivity C-reactive protein; apolipoprotein B; Killip class; left ventricular ejection fraction; amino-terminal pro-brain natriuretic peptide; multivessel disease; and number of stents. MACE: major adverse cardiovascular events, Lp(a): lipoprotein (a).

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