Elevated lipoprotein(a) levels as an independent predictor of long-term recurrent events in patients with acute coronary syndrome: an observational, retrospective cohort study

Abstract

Background Whether lipoprotein(a) [Lp(a)] is associated with recurrent cardiovascular events (RCVEs) still remains controversial. The present study aimed to investigate the prognostic value of Lp(a) for long-term RCVEs and each component of it in people with acute coronary syndrome (ACS). Methods This multicenter, observational and retrospective study enrolled 765 ACS patients at 11 hospitals in Chengdu from January 2014 to June 2019. Patients were assigned to low-Lp(a) group [Lp(a) < 30 mg/dl] and high-Lp(a) group [Lp(a) ≥ 30 mg/ dl]. The primary and secondary endpoints were defined as RCVEs and their elements, including all-cause death, nonfatal myocardial infarction (MI), nonfatal stroke and unplanned revascularization.Results Over a median 17-month follow-up, 113 (14.8%) patients presented with RCVEs were reported, among which we observed 57 (7.5%) all-cause deaths, 22 (2.9%) cases of nonfatal stroke, 13 (1.7%) cases of nonfatal MI and 33 (4.3%) cases of unplanned revascularization. The incidences of RCVEs and revascularization in the high-Lp(a) group were significantly higher than those in the low-Lp(a) group (P < 0.05), whereas rates of all-cause death, nonfatal stroke and nonfatal MI were not statistically different (P > 0.05). Kaplan-Meier analysis also revealed the same trend. Multivariate Cox proportional hazards analysis showed that 1-SD increase of Lp(a) was independently associated with both the primary endpoint event [hazard ratio (HR), 1.285 per 1-SD; 95% confidence interval (CI), 1.112-1.484; P < 0.001] and revascularization (HR, 1.588 per 1-SD; 95% CI, 1.305-1.932; P < 0.001), but not with the other secondary events. ConclusionIncreased Lp(a) is an independent predictor of RCVEs and unplanned revascularization in patients with ACS.

Prognostic value of elevated lipoprotein (a) in patients with acute coronary syndromes: a systematic review and meta-analysis

“…For instance, the FORTIAM investigation ( 20 ), a multicenter cohort study in Spain involving 1,371 acute myocardial infarction (AMI) patients across 15 hospitals, revealed a poorer prognosis in those with elevated Lp (a) levels at admission. Consistent findings were reported by Andrea Kallmeyer et al and Si-qi Yang et al ( 21 , 22 ). Conversely, a Vietnam-based observational cohort study ( 23 ) yielded disparate results, suggesting no correlation between Lp (a) levels ≥ 50 mg/dl during AMI and MACE or all-cause mortality.…”

“…Ultimately, 18 full-text articles, encompassing a total of 18,168 patients (13,843 male, 4,325 female), were selected for the comprehensive pooled analysis ( 20 – 23 , 25 – 28 , 33 – 42 ). Of these articles, 5 were prospective cohort studies ( 21 , 23 , 34 , 35 , 40 ), 10 were retrospective cohort studies ( 20 , 22 , 25 , 26 , 28 , 33 , 36 – 39 ), and 3 were observational cohorts ( 4 , 27 , 41 ). The encompassed investigations in this analysis spanned the period from 2009 to 2023.…”

“…Seven studies ( 22 , 23 , 25 , 27 , 33 , 34 , 40 ) were included in the analysis to investigate the relationship between elevated Lp (a) levels and the risk of all-cause mortality ( Figure 3A ). Utilizing a random-effects model, the pooled Hazard Ratio (HR) for all-cause mortality was 1.36 (95% CI: 1.05–1.76) when comparing high to low category of Lp (a) levels.…”

“…Extracted data from the studies included primary author, publication year, study duration, location, design, ACS types, sample size, follow-up duration, participant age, body mass index (BMI), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c) levels, history of prior medical therapy, diabetes prevalence, Lp (a) threshold, MACE, and mortality-related outcomes. For studies reporting continuous variables as median with range or interquartile range, a validated mathematical approach was employed to derive mean and standard deviation (21)(22)(23)(24)(25)(26)(27)(28).…”

Impact of Elevated Lipoprotein A on Clinical Outcomes in Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis

“…References: [12,15,19,[21][22][23][24][25][26] Secondary outcomes: Table 3 depicts the association between elevated Lp(a) levels and various clinical outcomes. RRs above 1 indicate an increased risk of adverse events in patients with elevated Lp(a).…”