Association of Lipoprotein(a) with coronary artery disease severity in acute myocardial infarction: evidence from a real-world cohort
S Azevedo, R Barbosa Sousa, D Silva Correia, A Moniz Garcia, C Santos-Jorge, M Presume, R Gomes, I Fonseca, M Trabulo, J Figueira, M Sousa Almeida, J FerreiraAbstract
Introduction
Lipoprotein(a) [Lp(a)] is a recognized independent risk factor for atherosclerotic cardiovascular diseases, including coronary artery disease (CAD). The objective of this study is to explore the association between serum levels of Lp(a) and previous myocardial infarction (MI) and/or coronary revascularization and the extension of obstructive CAD in patients with acute MI undergoing coronary angiography.
Methods
All consecutive patients with MI who underwent coronary angiography and Lp(a) measurement between May 2023 and October 2024 were included. Patient data were either registered prospectively or completed retrospectively using electronic health records. Lp(a) levels were measured via immunoturbidimetric assay and categorized as <75 nmol/L or >100 nmol/L. CAD severity was assessed by the number of major vessels (left main, left anterior descending, left circumflex and right coronary arteries) with stenosis >50% (CAD 0–2 vs. 3–4). Statistical analyses included chi-square tests and multivariable logistic regression adjusted for key cardiovascular risk factors.
Results
Patients with elevated Lp(a) levels (>100 nmol/L) showed a higher prevalence of previous cardiovascular events (myocardial infarction, percutaneous coronary intervention, Coronary Artery Bypass Graft; p = 0.037). Elevated Lp(a) was independently associated with a 2.7-fold increased risk of severe CAD (3–4 vessels >50% stenosis; OR = 2.696, 95% CI = 1.176–6.176, p = 0.019). Diabetes (OR = 3.910, p = 0.001) and hypertension (OR = 3.436, p = 0.027) were additional predictors, while HDL levels were protective (OR = 0.967, p = 0.049). The regression model demonstrated good discriminatory power (AUC = 0.780).
Conclusion
In this small real-world cohort population with acute MI, the number of previous MI or coronary revascularization was higher in patients with increased levels of Lp(a) and this marker of atherosclerotic disease was greater in patients with more extensive CAD.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.