Abstract 9281: Usefulness of Lipoprotein(a) to Predict Progression of Non-Culprit Coronary Lesions after Acute Myocardial Infarction for Paients with Normal Low-Density Lipoprotein Cholesterol

Abstract

Purpose: Lipoprotein(a) [Lp(a)] is associated with development of new coronary lesions after acute myocardial infarction (AMI) and Lp(a) value remains consistent within individuals across their lives. However, the efficacy of Lp(a) in patients with normal low-density lipoprotein cholesterol (LDL-C) was unclear. This study was undertaken to assess the efficacy of Lp(a) in patients with LDL-C. Methods: Lp(a) was measured 1 week after AMI in 410 patients who underwent primary percutanious coronary intervention (PCI) within 24 hours after symptom onset. Patients were stratified into two groups based on Lp(a); high Lp(a) group (>40mg/dl:n=95) was compared with low Lp(a) group. Furthermore, patients were stratified into two groups based on LDL-C; high LDL-C group (>120mg/dl) was compared with normal LDL-C group (≤120mg/dl). Clinical follow-up was obtained up to 1 years. Major Cardiac Coronary Event (MACE) was defined as cardiac death, myocardial infarction (MI) and/or revascularization for new lesions. Results: There was no significant difference with age, sex, hypertension, diabetes, infarct location, multivessel disease, final TIMI 3 and use of cardiovascular drugs between high Lp(a) group and low Lp(a) group. High Lp(a) was associated with higher 1-year cumulative incidence of MACE (25.2% vs 11.1%, p<0.001) and new lesion revascularization (22.1% vs 6.6%, p<0.001). Multivariate analysis showed that Lp(a) was an independent predictor for MACE (OR 1.64, 95% CI: 1.31-2.06, p<0.001) and new lesions requiring revascularization (OR 1.67, 95% CI: 1.32-2.13, p<0.001). In patients with normal LDL-C, Lp(a) was associated with the incidence of new lesion revascularization during 1-year (p=0.01, figure B) as same as in patients with high LDL-C (p=0.007, figure A). Conclusions: These results suggest that Lp(a) could predict MACE after AMI regardless of LDL-C.