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

Abstract

Background and ObjectivesAn 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 MethodsBetween 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}.ResultsThere 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).ConclusionIn patients in high Killip classes, high serum levels of Lp(a) were significantly associated with long-term adverse outcomes after AMI.

Association of lipoprotein(a) with long‐term mortality following coronary angiography or percutaneous coronary intervention

“…In our study, Lp(a) levels were an independent prognostic factor for long‐term mortality with an HR of 1.97 (95% CI: 1.08‐3.58) in patients undergoing CAG or PCI, whereas in‐hospital mortality was not significantly different between the 2 groups (0.5% vs 0.8%; P = 0.364). A Korean study also revealed that in‐hospital mortality was not significantly different according to Lp(a) tertiles . These might be due to the limited number of patients in our study population, which interpreted the accuracy of results.…”

“…A Korean study also revealed that in-hospital mortality was not significantly different according to Lp(a) tertiles. 13 These might be due to the limited number of patients in our study population, which interpreted the accuracy of results.…”

<p>High Lipoprotein(a) Levels as a Predictor of Major Adverse Cardiovascular Events in Hospitalized-Acute Myocardial Infarction Patients</p>

“…Other studies also used higher cut-offs (>30 mg/ dL), but these values were based on the prediction of coronary heart disease rather than MACE in acute AMI conditions. [29][30][31] Currently, there is no definite cut-off point for Lp(a) as a predictor of in-hospital MACE for AMI patients.…”

Association between Lipoprotein (a) level on admission and the incidence of subsequent cardiovascular events in patients with acute coronary syndrome

“…Cho JY et al found that high serum levels of Lp(a) were significantly associated with long-term adverse outcomes in AMI patients in high Killip (III-IV) classes, not in lower Killip (I-II) classes [19]. The analysis in present study may lead to an impression that this effect only exists in unstable angina patients, while not in AMI patients.…”