Lipoprotein(a) as a predictor of major adverse cardiovascular events in patients with very premature (≤40 years) acute coronary syndrome: long-term follow-up of the STudy of eArly Myocardial INfArction.

IF 2.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Coronary artery disease Pub Date : 2026-09-01 Epub Date: 2026-03-09 DOI:10.1097/MCA.0000000000001627

Loukianos S Rallidis, Sofia-Panagiota Giannakopoulou, Christos Kotakos, Stylianos Armylagos, Stylianos L Rallidis, Eleni P Stathopoulou, Konstantinos A Papathanasiou, Demosthenes Panagiotakos

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引用次数: 0

Abstract

Background: Lipoprotein(a) [Lp(a)] is a causal risk factor for cardiovascular disease, and it is particularly associated with premature acute coronary syndrome (ACS). We investigated whether elevated Lp(a) can predict recurrent cardiovascular events in patients who experienced their first ACS less than or equal to 40 years of age.

Methods: Within the STudy of eArly Myocardial INfArction registry, we recruited 405 consecutive patients who survived their first ACS less than or equal to 40 years of age; of them 378 had complete follow-up data. Clinical endpoint was the development of major adverse cardiovascular events (MACE; i.e. cardiac death, readmission for ACS or malignant ventricular arrhythmias, ischemic stroke, or coronary revascularization due to clinical deterioration). Multi-adjusted Cox regression was used to assess the association between Lp(a) and first recurrent MACE risk.

Results: Of the 378 ACS survivors (33.7 ± 4.3 years), 139 (36.8%) experienced a MACE over a median 8-year (5.2-12.5 years) follow-up. Elevated Lp(a) showed a borderline independent association with higher recurrent MACE [hazard ratio per 1 mg/dl: 1.004, 95% confidence interval (CI): 0.999-1.009, P = 0.051]. Moreover, patients with baseline Lp(a) levels greater than or equal to 50 mg/dl had 82.6% higher risk of MACE as compared with those below (hazard ratio 1.826, 95% CI: 1.141-2.925, P = 0.012); similarly, patients with Lp(a) ≥ 70 mg/dl had 118% higher risk as compared with those below (hazard ratio 2.180, 95% CI: 1.330-3.573, P = 0.002).

Conclusion: Elevated Lp(a) concentrations demonstrate an independent association with recurrent MACE among very young ACS survivors. Until targeted Lp(a)-lowering treatments become clinically available, an aggressive lipid-lowering approach may be warranted to partially attenuate Lp(a)-related residual cardiovascular risk.

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脂蛋白(a)作为极早（≤40年）急性冠状动脉综合征患者主要不良心血管事件的预测因子：早期心肌梗死研究的长期随访研究

背景：脂蛋白(a) [Lp(a)]是心血管疾病的一个因果危险因素，尤其与早发急性冠脉综合征（ACS）相关。我们研究了Lp(a)升高是否可以预测40岁以下首次发生ACS的患者的心血管事件复发。方法：在早期心肌梗死登记研究中，我们招募了405名连续存活的患者，他们的第一次ACS小于或等于40岁；其中378例随访资料完整。临床终点为主要心血管不良事件（MACE，即心源性死亡、ACS再入院或恶性室性心律失常、缺血性中风或因临床恶化导致冠状动脉血运重建术）的发生。采用多因素校正Cox回归评估Lp(a)与首次复发MACE风险之间的关系。结果：在378例ACS幸存者（33.7±4.3年）中，139例（36.8%）在中位8年（5.2-12.5年）随访期间经历了MACE。升高的Lp(a)与较高的复发性MACE呈临界独立关联[每1 mg/dl的危险比：1.004,95%可信区间（CI）： 0.999-1.009, P = 0.051]。此外，基线Lp(a)水平大于或等于50 mg/dl的患者发生MACE的风险比低于50 mg/dl的患者高82.6%（风险比1.826,95% CI: 1.141-2.925, P = 0.012）；同样，Lp(a)≥70 mg/dl的患者的风险比低于70 mg/dl的患者高118%（风险比2.180,95% CI: 1.330-3.573, P = 0.002）。结论：在非常年轻的ACS幸存者中，Lp(a)浓度升高与MACE复发有独立的关联。在靶向Lp(a)降低治疗成为临床可用之前，可能需要积极的降脂方法来部分减弱Lp(a)相关的剩余心血管风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Coronary artery disease 医学-外周血管病

CiteScore

2.50

自引率

0.00%

发文量

190

审稿时长

6-12 weeks

期刊介绍： Coronary Artery Disease welcomes reports of original research with a clinical emphasis, including observational studies, clinical trials, translational research, novel imaging, pharmacology and interventional approaches as well as advances in laboratory research that contribute to the understanding of coronary artery disease. Each issue of Coronary Artery Disease is divided into four areas of focus: Original Research articles, Review in Depth articles by leading experts in the field, Editorials and Images in Coronary Artery Disease. The Editorials will comment on selected original research published in each issue of Coronary Artery Disease, as well as highlight controversies in coronary artery disease understanding and management. Submitted artcles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.