SPC365

Lipoprotein (a) as a risk marker for worse outcomes in acute myocardial infarction patients

Session: Comunicações Orais - Sessão 15 - Síndrome coronária aguda 2
Speaker: Catarina Amaral Marques

Congress: CPC 2024
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.7 Acute Coronary Syndromes - Other
Session Type: Comunicações Orais
FP Number: ---
Authors: Catarina Amaral Marques; André Cabrita; Luís Santos; Ana Isabel Pinho; Cátia Oliveira; Pedro Palma; Miguel Rocha; Helena Santos Moreira; Paulo Maia Araújo; Cristina Cruz; Rui André Rodrigues

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction:</strong> Lipoprotein(a) <span style="color:black">[Lp(a)] </span>is an increasingly acknowledged modulator/contributor to cardiovascular (CV) risk. However, its impact on acute or follow-up (FU) outcomes in patients (pts) admitted with acute myocardial infarction (AMI) is still poorly understood. Our aim was to evaluate Lp(a) relation with CV outcomes in pts admitted with AMI. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods:</strong> Tertiary care centre retrospective study of pts admitted with type one AMI between 2020&nbsp;and 2023, in whom Lp(a) assessment was performed at admission (n=162). Data was based on pts&rsquo; medical records review. A focused analysis was then performed on pts presenting higher Lp(a) values (defined as Lp(a) &ge; than the 3<sup>rd</sup> quartile (3Q) cut-off value identified in our cohort). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:</strong> A total of 162 pts were included: 19% were female; median age at AMI was 54 years old; 95% presented &ge;1 CV risk factor (CVRF). <span style="color:black">Non-ST/ST segment elevation AMI frequency&nbsp;was </span>46% and 54%, respectively. Median FU time was 24 months. Median Lp(a) value was 35.5 mg/dL, and the 3Q cut-off was 81.6 mg/dL. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Focusing pts with Lp(a)&ge;3Q (n=40), no differences were found regarding baseline characterization (vs Lp(a)&lt;3Q), namely in CVRF (p=0.12), sex (p=0.25), age (p=0.7), or frequency of previous CV events (p=0.6). Lipid panel at admission, namely low-density lipoprotein (LDL) cholesterol (p=0.5), was not significantly different between groups. However, Lp(a)&ge;3Q presented more frequently on pre-AMI antidyslipidemic drug treatment (p=0.02), as well as on higher-intensity drug regimens (p=0.02). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Regarding in-hospital management and outcomes, both groups were globally comparable, namely in terms of access to coronariography (p=0.6), revascularization (p=0.08), Killip classification (p=0.8), left ventricular dysfunction (p=0.6) or post-AMI complications (p=0.2).&nbsp; </span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Concerning FU outcomes, time-to-CV-event analysis was performed and showed significant differences between groups (Log-rank=0.027; Figure 1). Mean time-to-first CV-event was 8&plusmn;7 months(m) in the Lp(a)&ge;3Q group versus 20&plusmn;12m in Lp(a)&lt;3Q. Overall, 8% of all pts presented a CV event on FU, namely a new AMI episode in 6% and heart failure hospitalization in 2%. One CV death was observed during the FU.</span></span></span></p>

<p style="text-align:justify"><strong><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Conclusion:</span></span></strong><span style="font-size:12pt"><span style="color:#000000"><span style="font-family:Calibri,sans-serif"> Although baseline characteristics were comparable, particularly concerning the lipid panel at admission, pts with higher Lp(a) values presented worse CV outcomes on FU, with significant differences on survival analysis. Our work raises awareness for this especially high-risk subgroup of AMI pts. Further studies are urgently needed to better characterize these pts&rsquo; risk and address optimal management strategies, aiming to minimize their CV burden.&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;</span></span></span></p>