Kallmeyer Andrea, Pello Lázaro Ana María, Blanco-Colio Luis M, Aceña Álvaro, González-Lorenzo Óscar, Tarín Nieves, Cristóbal Carmen, Gutiérrez-Landaluce Carlos, Huelmos Ana, Lumpuy-Castillo Jairo, López-Castillo Marta, Montalvo Juan Manuel, Alonso Martin Joaquín J, López-Bescós Lorenzo, Egido Jesús, Lorenzo Óscar, Tuñón José
Department of Cardiology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain.
Faculty of Medicine, Autónoma University, 28029 Madrid, Spain.
J Clin Med. 2023 Jan 26;12(3):960. doi: 10.3390/jcm12030960.
The pathophysiological mechanisms underlying Myocardial Infarction with Non-Obstructive Coronary Artery Disease (MINOCA) are still under debate. Lipoprotein (a) [Lp(a)] has proinflammatory and prothrombotic actions and has been involved in the pathogenesis of atherosclerosis. However, no previous studies have linked Lp(a) levels with the probability of developing MINOCA. Moreover, the relationship between MINOCA and the plasma levels of other proatherogenic and proinflammatory molecules such as Interleukin-18 (IL18) and proprotein convertase subtilisin/kexin type 9 (PCSK9) has not been studied. We conducted a prospective, multicenter study involving 1042 patients with acute myocardial infarction (AMI). Seventy-six patients had no significant coronary lesions. All patients underwent plasma analysis on admission. MINOCA patients were younger (57 (47-68) vs. 61 (52-72) years; = 0.010), more frequently female (44.7% vs. 21.0%; < 0.001), and had lower rates of diabetes and of Lp(a) > 60 mg/dL (9.2% vs. 19.8%; = 0.037) than those with coronary lesions; moreover, High Density Lipoprotein cholesterol (HDL-c) levels were higher in MINOCA patients. The absence of Lp(a) > 60 mg/dL and of diabetes were independent predictors of MINOCA, as well as female sex, high HDL-c levels, and younger age. IL-18 and PCSK9 levels were not predictors of MINOCA. During a follow-up of 5.23 (2.89, 7.37) years, the independent predictors of the primary outcome (acute ischemic events or death) in the whole sample were Lp(a) > 60 mg/dL, older age, low estimated Glomerular Filtration rate (eGFR), hypertension, previous heart failure (HF), coronary artery bypass graft, use of insulin, and no therapy with acetylsalicylic acid. In conclusion, in AMI patients, the absence of high Lp(a) levels, as well high HDL-c levels, were independent predictors of the inexistence of coronary artery disease. High Lp (a) levels were also an independent predictor of ischemic events or death.
非阻塞性冠状动脉疾病所致心肌梗死（MINOCA）的病理生理机制仍存在争议。脂蛋白（a）[Lp（a）]具有促炎和促血栓形成作用，并参与动脉粥样硬化的发病机制。然而，既往尚无研究将Lp（a）水平与发生MINOCA的可能性联系起来。此外，MINOCA与其他促动脉粥样硬化和促炎分子如白细胞介素-18（IL18）和前蛋白转化酶枯草溶菌素/kexin 9型（PCSK9）的血浆水平之间的关系尚未得到研究。我们进行了一项前瞻性、多中心研究，纳入了1042例急性心肌梗死（AMI）患者。76例患者无明显冠状动脉病变。所有患者入院时均接受血浆分析。MINOCA患者较年轻（57（47 - 68）岁 vs. 61（52 - 72）岁；P = 0.010），女性比例更高（44.7% vs. 21.0%；P < 0.001），糖尿病和Lp（a）> 60 mg/dL的发生率低于有冠状动脉病变的患者（9.2% vs. 19.8%；P = 0.037）；此外，MINOCA患者的高密度脂蛋白胆固醇（HDL-c）水平更高。Lp（a）> 60 mg/dL和糖尿病的缺失是MINOCA的独立预测因素，以及女性性别、高HDL-c水平和较年轻的年龄。IL-18和PCSK9水平不是MINOCA的预测因素。在5.23（2.89，7.37）年的随访期间，整个样本中主要结局（急性缺血事件或死亡）的独立预测因素为Lp（a）> 60 mg/dL、年龄较大、估计肾小球滤过率（eGFR）较低、高血压、既往心力衰竭（HF）、冠状动脉旁路移植术、使用胰岛素以及未接受阿司匹林治疗。总之，在AMI患者中，Lp（a）水平不高以及HDL-c水平高是冠状动脉疾病不存在的独立预测因素。高Lp（a）水平也是缺血事件或死亡的独立预测因素。
