J Korean Med Sci.  2023 Apr;38(13):e102. 10.3346/jkms.2023.38.e102.

Baseline Lipoprotein(a) Levels and Long-Term Cardiovascular Outcomes After Acute Myocardial Infarction

• Park JS
• Cho KH
• Hong YJ
• Kim MC
• Sim DS
• Kim JH
• Ahn Y
• Jeong MH

• KMID: 2541043
• DOI: http://doi.org/10.3346/jkms.2023.38.e102

Abstract

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%; logrank 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.

Keyword

Lipoprotein(a); Myocardial Infarction; Stroke; Death

Figure

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  Fig. 1 Flow chart of the study population. Data of the study population was derived from Chonnam National University Hospital in Korea.AMI = acute myocardial infarction, Lp(a) = lipoprotein(a), BMI = body mass index, LVEF = left ventricular ejection fraction, TC = total cholesterol, eGFR = estimated glomerular filtration rate.

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  Fig. 2 Distribution of lipoprotein(a) levels. Bars indicate the number of patients grouped according to lipoprotein(a) levels at 20 mg/dL intervals.

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  Fig. 3 Cumulative incidence of 3P-MACE for the overall patient population. Kaplan-Meier curves for 3P-MACE (three-point major adverse cardiovascular events) over 3 years among the 3 groups are shown. Adjusted P value are derived from the Cox time-to-event multivariable analysis between patients with Lp(a) < 30 mg/dL and those with Lp(a) ≥ 50 mg/dL.Lp(a) = lipoprotein(a), 3P-MACE = three-point major adverse cardiovascular events.

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  Fig. 4 Cumulative incidence of 3P-MACE among patients with NSTEMI (A) and STEMI (B). Kaplan-Meier curves for 3P-MACE (three-point major adverse cardiovascular events) over 3 years among the 3 groups are shown.Lp(a) = lipoprotein(a), NSTEMI = non-ST-segment elevation myocardial infarction, 3P-MACE = three-point major adverse cardiovascular events, STEMI = ST-segment elevation myocardial infarction.

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