Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
J Korean Med Sci. 2023 Apr 3;38(13):e102. doi: 10.3346/jkms.2023.38.e102.
Lipoprotein(a) is a known independent risk factor for atherosclerotic cardiovascular disease. However, the prognostic impact of the baseline lipoprotein(a) levels on long-term clinical outcomes among patients with acute myocardial infarction remain unclear.
We analyzed 1,908 patients with acute myocardial infarction from November 2011 to October 2015 from a single center in Korea. They were divided into 3 groups according to their baseline lipoprotein(a) levels: groups I (< 30 mg/dL, n = 1,388), II (30-49 mg/dL, n = 263), and III (≥50 mg/dL, n = 257). Three-point major adverse cardiovascular events (a composite of nonfatal myocardial infarction, nonfatal stroke, and cardiac death) at 3 years were compared among the 3 groups.
The patients were followed for 1094.0 (interquartile range, 1,033.8-1,095.0) days, during which a total of 326 (17.1%) three-point major adverse cardiovascular events occurred. Group III had higher rates of three-point major adverse cardiovascular events compared with Group I (23.0% vs. 15.7%; log-rank = 0.009). In the subgroup analysis, group III had higher rates of three-point major adverse cardiovascular events compared with group I in patients with non-ST-segment elevation myocardial infarction (27.0% vs. 17.1%; log-rank = 0.006), but not in patients with ST-segment elevation myocardial infarction (14.4% vs. 13.3%; log-rank = 0.597). However, in multivariable Cox time-to-event models, baseline lipoprotein(a) levels were not associated with an increased incidence of three-point major adverse cardiovascular events, regardless of the type of acute myocardial infarction. Sensitivity analyses in diverse subgroups showed similar findings to those of the main analysis.
Baseline lipoprotein(a) levels in Korean patients with acute myocardial infarction were not independently associated with increased major adverse cardiovascular events at 3 years.
脂蛋白(a)是动脉粥样硬化性心血管疾病的已知独立危险因素。然而，急性心肌梗死患者的基线脂蛋白(a)水平对长期临床结局的预后影响尚不清楚。
我们分析了 2011 年 11 月至 2015 年 10 月来自韩国一个单一中心的 1908 例急性心肌梗死患者。他们根据基线脂蛋白(a)水平分为 3 组：I 组(<30mg/dL，n=1388)、II 组(30-49mg/dL，n=263)和 III 组(≥50mg/dL，n=257)。比较了 3 组患者 3 年时的 3 点主要不良心血管事件(非致命性心肌梗死、非致命性卒中和心脏性死亡的复合终点)。
患者平均随访 1094.0(四分位间距，1033.8-1095.0)天，期间共发生 326 例(17.1%)3 点主要不良心血管事件。III 组的 3 点主要不良心血管事件发生率高于 I 组(23.0%比 15.7%；log-rank = 0.009)。亚组分析显示，非 ST 段抬高型心肌梗死患者中，III 组的 3 点主要不良心血管事件发生率高于 I 组(27.0%比 17.1%；log-rank = 0.006)，而 ST 段抬高型心肌梗死患者中两组间无显著差异(14.4%比 13.3%；log-rank = 0.597)。然而，在多变量 Cox 时间事件模型中，无论急性心肌梗死类型如何，基线脂蛋白(a)水平均与 3 点主要不良心血管事件发生率的增加无关。在不同亚组的敏感性分析中，也得到了与主要分析相似的结果。
韩国急性心肌梗死患者的基线脂蛋白(a)水平与 3 年内主要不良心血管事件的发生无关。
