Background Inconclusive data exist on risk associated with Lipoprotein(a) (Lp[a]) in patients after myocardial infarction (MI). Aims of the present study were to evaluate the association between Lp(a) level and (1) total mortality, (2) recurrent cardiovascular events, and (3) the need for glycoprotein IIb/IIIa inhibitors administration.
Design and Methods Single center prospective registry of consecutive patients hospitalized for acute myocardial infarction between June 2017 and June 2020 at a large tertiary cardiac center.
Results Data from 851 consecutive patients hospitalized for MI were evaluated. During the median follow-up of 19 months (IQR 10-27), 58 (6.8%) patients died. Nonlinear modelling revealed a U-shaped association between Lp(a) and mortality risk. Compared to patients with Lp(a) ranging between 10-30 nmol/L and after multivariate adjustment, total mortality risk was increased both in patients with Lp(a)<7 nmol/L (HR 4.08, 95% CI 1.72-9.68) and Lp(a) ≥125 nmol/L (HR 2.92, 95% CI 1.16-7.37), respectively. In the competing risk model with total mortality analyzed as a competing risk, patients with low Lp(a) were at increased risk of hospitalization for acute coronary syndrome recurrence or heart failure (SHR 2.94, 95% CI 1.52-5.68). During the index hospitalization, low Lp(a) was independently associated with glycoprotein IIb/IIIa inhibitors use (OR 1.69, (95% CI 1.05-2.73).
Conclusions Both high and low concentrations of Lp(a) are associated with increased risk of mortality after MI. The excess of mortality associated with Lp(a) is attributable to more prevalent heart failure and coronary syndrome recurrence. Furthermore, low L(a) is associated with a higher rate of glycoprotein IIb/IIIa inhibitors use.
