Effect of Lipoprotein (a) Levels on Long-term Cardiovascular Outcomes in Patients with Myocardial Infarction with Nonobstructive Coronary Arteries
Section snippets
Methods
This was a single-center, prospective and observational cohort study of patients with MINOCA. From January 2015 to December 2019, a total of 23460 unique AMI patients with coronary angiography were consecutively admitted to Fuwai hospital, including non ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI). Patients were identified as having MINOCA if their diagnosis met the 4th universal definition of AMI 22 and the coronary angiogram did
Results
Similar with previous studies, we adopted the Lp(a) cut-off value of 10 and 30mg/dL and divided the patients with MINOCA as low, medium, and high Lp(a) groups [Low: Lp (a) <10 mg/dL, n = 366; Medium: 10 ≤ Lp(a) < 30 mg/dL, n = 463; High: Lp (a) ≥30 mg/dL, n = 350] (Figure 1). The plasma Lp (a) concentrations were skewedly distributed in the population (Figure 2). As shown in Table 1, patients with higher Lp(a) level were more often female and had higher values of TC, LDL-C, and ApoB. There were
Discussion
The present study, firstly, verified the prognostic power of the Lp(a) level in patients with MINOCA, and found that elevated Lp (a) was strongly associated with an increased risk of MACE after MINOCA. Incorporating Lp (a) to TIMI risk score further improved the outcome prediction. These data support the utility of Lp(a) for risk stratification in the contemporary real-world management of MINOCA.
MINOCA represents a distinct entity and the underlying mechanisms are varied and may include plaque
CRediT Author Statement
Side Gao M.D.: Conceptualization, Methodology, Investigation, Data collection, Data curation, Formal analysis, Writing-Original Draft; Wenjian Ma M.D.: Conceptualization, Methodology, Investigation, Data collection, Validation, Formal analysis, Writing-Reviewing and Editing; Sizhuang Huang M.D.: Investigation, Data collection, Writing-Reviewing and Editing; Xuze Lin M.D.: Investigation, Data collection, Writing-Reviewing and Editing; Mengyue Yu M.D., PhD.: Supervision, Writing-Reviewing and
Competing interest
The authors declare that they have no competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgment
This work was supported by National Natural Science Foundation of China (81670415).
Disclosure
The authors have no conflicts of interest to disclose.
References (30)
- et al.
Population-level incidence and outcomes of myocardial infarctionwith non-obstructive coronary arteries (MINOCA): insights from the Alberta contemporary acute coronary syndrome patients invasive treatment strategies (COAPT) study
Int J Cardiol
(2018) - et al.
Myocardial infarction with non-obstructive coronary arteries (MINOCA) in Chinese patients: clinical features, treatment and 1 year follow-up
Int J Cardiol
(2019) A test in context: lipoprotein(a): diagnosis, prognosis, controversies, and emerging therapies
J Am Coll Cardiol
(2017)- et al.
Discrimination and net reclassification of cardiovascular risk with lipoprotein(a): prospective 15-year outcomes in the Bruneck Study
J Am Coll Cardiol
(2014) - et al.
Lipoprotein(a) for risk assessment in patients with established coronary artery disease
J Am Coll Cardiol
(2014) - et al.
Baseline and on-statin treatment lipoprotein(a) levels for prediction of cardiovascular events: individual patient-data meta-analysis of statin outcome trials
Lancet
(2018) - et al.
Association between lipoprotein (a) level on admission and the incidence of subsequent cardiovascular events in patients with acute coronary syndrome
Int J Cardiol
(2012) - et al.
Lipoprotein(a) levels and risk of cardiovascular disease events in individuals with diabetes mellitus or prediabetes: the atherosclerosis risk in communities study
Atherosclerosis
(2019) - et al.
Impact of lipoprotein(a) as residual risk on long-term outcomes in patients after percutaneous coronary intervention
Am J Cardiol
(2015) - et al.
Executive group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/AmericanHeart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction.Fourth Universal Definition of Myocardial Infarction (2018)
J Am Coll Cardiol
(2018)