Saeki Yasuhiko, Sawaguchi Jun, Akita Satori, Takamura Taka-Aki, Fujibayashi Kosuke, Wakasa Minoru, Akao Hironobu, Kitayama Michihiko, Kawai Yasuyuki, Kajinami Kouji
Department of Cardiology, Kanazawa Medical University, Uchinada 9200293, Japan.
Trans-catheter Cardiovascular Therapeutics, Kanazawa Medical University, Uchinada 9200293, Japan.
World J Cardiol. 2024 Jun 26;16(6):329-338. doi: 10.4330/wjc.v16.i6.329.
Lipoprotein(a) [Lp(a)] is a causal risk factor for atherosclerotic cardiovascular diseases; however, its role in acute coronary syndrome (ACS) remains unclear.
To investigate the hypothesis that the Lp(a) levels are altered by various conditions during the acute phase of ACS, resulting in subsequent cardiovascular events.
From September 2009 to May 2016, 377 patients with ACS who underwent emergent coronary angiography, and 249 who completed ≥ 1000 d of follow-up were enrolled. Lp(a) levels were measured using an isoform-independent assay at each time point from before percutaneous coronary intervention (PCI) to 48 h after PCI. The primary endpoint was the occurrence of major adverse cardiac events (MACE; cardiac death, other vascular death, ACS, and non-cardiac vascular events).
The mean circulating Lp(a) level decreased significantly from pre-PCI (0 h) to 12 h after (19.0 mg/dL to 17.8 mg/dL, < 0.001), and then increased significantly up to 48 h after (19.3 mg/dL, < 0.001). The changes from 0 to 12 h [Lp(a)Δ0-12] significantly correlated with the basal levels of creatinine [Spearman's rank correlation coefficient (SRCC): -0.181, < 0.01] and Lp(a) (SRCC: -0.306, < 0.05). Among the tertiles classified according to Lp(a)Δ0-12, MACE was significantly more frequent in the lowest Lp(a)Δ0-12 group than in the remaining two tertile groups (66.2% 53.6%, = 0.034). A multivariate analysis revealed that Lp(a)Δ0-12 [hazard ratio (HR): 0.96, 95% confidence interval (95%CI): 0.92-0.99] and basal creatinine (HR: 1.13, 95%CI: 1.05-1.22) were independent determinants of subsequent MACE.
Circulating Lp(a) levels in patients with ACS decreased significantly after emergent PCI, and a greater decrease was independently associated with a worse prognosis.
脂蛋白(a)[Lp(a)]是动脉粥样硬化性心血管疾病的一个因果风险因素；然而，其在急性冠状动脉综合征(ACS)中的作用仍不清楚。
探讨在ACS急性期各种情况会改变Lp(a)水平，从而导致随后心血管事件发生的这一假说。
2009年9月至2016年5月，纳入377例行急诊冠状动脉造影的ACS患者，以及249例完成≥1000天随访的患者。在从经皮冠状动脉介入治疗(PCI)前到PCI后48小时的每个时间点，使用一种不依赖异构体的检测方法测量Lp(a)水平。主要终点是主要不良心脏事件(MACE；心源性死亡、其他血管性死亡、ACS和非心脏血管事件)的发生。
循环Lp(a)平均水平从PCI前(0小时)到术后12小时显著下降(从19.0mg/dL降至17.8mg/dL，P<0.001)，然后到术后48小时显著升高(19.3mg/dL，P<0.001)。0至12小时的变化[Lp(a)Δ0-12]与肌酐基础水平[Spearman等级相关系数(SRCC)：-0.181，P<0.01]和Lp(a)(SRCC：-0.306，P<0.05)显著相关。在根据Lp(a)Δ0-12分类的三分位数中，最低Lp(a)Δ0-12组的MACE发生率显著高于其余两个三分位数组(66.2%对53.6%，P=0.034)。多变量分析显示，Lp(a)Δ0-12[风险比(HR)：0.96，95%置信区间(95%CI)：0.92-0.99]和基础肌酐(HR：1.13，95%CI：1.05-1.22)是随后发生MACE的独立决定因素。
ACS患者急诊PCI后循环Lp(a)水平显著下降，下降幅度越大，独立预后越差。
