Usefulness of lipoprotein (a) for predicting progression of non-culprit coronary lesions after acute myocardial infarction

Background: The serum lipoprotein (a) [Lp(a)] level is genetically determined and remains consistent during a person's life. Previous cohort studies have reported that subjects with a high Lp(a) level are at high risk of cardiac events. Methods and Results: This study consisted of 410 patients who underwent primary percutaneous coronary intervention within 24 h of the onset of acute myocardial infarction (AMI). Lp(a) was measured 1 week after AMI and patients were divided into 2 groups based: high Lp(a) group (>40 mg/dl, n=95) and low Lp(a) group (≤40 mg/dl, n= 315). A major adverse cardiac event (MACE) was defined as cardiac death, myocardial infarction and/or revascularization for new lesions. The incidence of MACE during 5 years was significantly higher in the high Lp(a) group than in the low Lp(a) group (34.7% vs. 16.5%, P<0.001). This difference was primarily driven by a higher incidence of new lesions requiring revascularization in the high Lp(a) group (31.6% vs. 15.2%, P<0.001). Multivariate analysis showed that Lp(a) was an independent predictor for MACE (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.31-2.06, P<0.001) and revascularization of a new lesion (OR 1.61, 95%CI 1.32-2.13, P<0.001). Conclusions: Lp(a) levels could predict the progression of the non-culprit coronary lesions after AMI.