脂蛋白（a）与ST段抬高型急性心肌梗死后的长期复发性梗死

Lipoprotein(a) and long-term recurrent infarction after an episode of ST-segment elevation acute myocardial infarction.

作者信息

Miñana Gema, Gil-Cayuela Carolina, Bodi Vicent, de la Espriella Rafael, Valero Ernesto, Mollar Anna, Marco Maria, García-Ballester Teresa, Zorio Begoña, Fernández-Cisnal Agustín, Chorro Francisco J, Sanchis Juan, Núñez Julio

机构信息

Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA.

Cardiocirculatory Unit, Health Research Institute of La Fe University Hospital (IIS La Fe), Valencia, Spain.

出版信息

Coron Artery Dis. 2020 Jun;31(4):378-384. doi: 10.1097/MCA.0000000000000852.

DOI:10.1097/MCA.0000000000000852

PMID:32040026

Abstract

BACKGROUND

In established ischemic heart disease, the relationship between lipoprotein(a) and new cardiovascular events showed contradictory results. Our aim was to assess the relationship between lipoprotein(a) and very long-term recurrent myocardial infarction (MI) after an index episode of ST-segment elevation acute myocardial infarction (STEMI).

METHODS

We included 435 consecutive STEMI patients discharged from October 2000 to June 2003 in a single teaching center. The relationship between lipoprotein(a) at discharge and recurrent MI was evaluated through negative binomial regression and Cox regression analysis.

RESULTS

The mean age was 65 years (55-74 years), 25.5% were women, 34.7% were diabetic, and 66% had a MI of anterior location. Fibrinolysis, rescue, or primary angioplasty was performed in 215 (49.4%), 19 (4.4%), and 18 (4.1%) patients, respectively. The median lipoprotein(a) was 30.4 mg/dL (12-59.4 mg/dL). After a median follow-up of 9.6 years (4.1-15 years), 180 (41.4%) deaths and 187 MI in 133 (30.6%) patients were recorded. After a multivariate adjustment, the risk gradient of lipoprotein(a) showed a neutral effect along most of the continuum and only extreme higher values identified those at higher risk of recurrent MI (P = 0.020). Those with lipoprotein(a) values >95th percentile (≥135 mg/dL) showed a higher risk of recurrent MI (incidence rate ratio, 2.34; 95% confidence interval, 1.37-4.02; P = 0.002). Lipoprotein(a) was not related to the risk of mortality (P = 0.245).

CONCLUSIONS

After an episode of STEMI, only extreme high values of lipoprotein(a) were associated with an increased risk of long-term recurrent MI.

摘要

背景

在已确诊的缺血性心脏病中，脂蛋白(a)与新发心血管事件之间的关系呈现出相互矛盾的结果。我们的目的是评估脂蛋白(a)与ST段抬高型急性心肌梗死（STEMI）首次发作后极长期复发性心肌梗死（MI）之间的关系。

方法

我们纳入了2000年10月至2003年6月在单一教学中心出院的435例连续性STEMI患者。通过负二项回归和Cox回归分析评估出院时脂蛋白(a)与复发性MI之间的关系。

结果

平均年龄为65岁（55 - 74岁），女性占25.5%，糖尿病患者占34.7%，前壁心肌梗死患者占66%。分别有215例（49.4%）、19例（4.4%）和18例（4.1%）患者接受了纤溶治疗、补救治疗或直接经皮冠状动脉介入治疗。脂蛋白(a)的中位数为30.4mg/dL（12 - 59.4mg/dL）。在中位随访9.6年（4.1 - 15年）后，记录到180例（41.4%）死亡，133例（30.6%）患者发生187次心肌梗死。经过多变量调整后，脂蛋白(a)的风险梯度在大部分连续区间显示出中性效应，只有极高值才确定那些有更高复发性MI风险的患者（P = 0.020）。脂蛋白(a)值>第95百分位数（≥135mg/dL）的患者复发性MI风险更高（发病率比，2.34；95%置信区间，1.37 - 4.02；P = 0.002）。脂蛋白(a)与死亡风险无关（P = 0.245）。