SPC365

Lipoprotein (a): what role in long-term prognosis of patients with acute myocardial infarction

Session: Sessão de Posters 20 - Doença coronária - marcadores de prognóstico
Speaker: Jéni Quintal

Congress: CPC 2024
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type: Cartazes
FP Number: ---
Authors: Jéni Quintal; Rui Antunes Coelho; Catarina Lagoas Pohle; Joana Silva Ferreira; Patrícia Bernardes; Tatiana Duarte; Sara Gonçalves; Filipe Seixo
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Background:&nbsp;</span></span></span></strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Lipoprotein(a) is a known risk factor for atherosclerotic coronary heart disease. This genetically regulated protein is constant throughout the individual lifetime and therefore a single measurement may estimate the individual risk of coronary artery disease (CAD). Nonetheless, its impact on long-term prognosis of patients (pts) with acute myocardial infarction (AMI) is not well stablished.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Aim</span></span></span></strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">: </span></span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">To assess whether lipoprotein(a) (Lpa) level can predict long-term prognosis of pts hospitalized for acute myocardial infarction, based on all-cause mortality, readmission due to acute coronary syndrome (ACS) and readmission due to major cardiovascular disease (CVD).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Methods</span></span></span></strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">: We performed a single-center retrospective cohort study. Consecutive</span></span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black"> pts admitted in our center between 1 November 2021 and 31 October 2022 with ACS were included (n=390). Patient without Lpa measurement at admission were excluded (n=62). Patients were divided in 2 groups according to Lpa level upon hospital admission: gA - normal Lpa level (Lpa &lt; 30 mg/dL) - and gB &ndash; high Lpa level (Lpa </span></span></span><em><span style="font-size:9.0pt"><span style="font-family:&quot;Cambria Math&quot;,serif"><span style="color:black">&ge;</span></span></span></em><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> </span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">&nbsp;30 mg/dL). Cardiovascular risk factors and relevant comorbidities were assessed in both groups. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">The type of ACS, the number of affected coronary arteries, left ventricle ejection fraction (LVEF), Kilipp Kimball (KK) class, the presence of significant arrhythmias, high-sensitivity troponin (hs-TnI) and NT-proBNP levels were evaluated in both groups. Long term prognosis analysis included long-term all cause mortality, hospital readmission due to ACS and hospital readmission due to major CVD. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Results: </span></span></span></strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">The study included 328 pts, with a mean age of 66 (</span></span></span><em><span style="font-size:9.0pt"><span style="font-family:&quot;Cambria Math&quot;,serif"><span style="color:#1d1d1d">&plusmn;</span></span></span></em><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> </span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">&nbsp;12) years-old and a 71.6% male prevalence. Regarding baseline characteristics of individuals, gB had a higher prevalence of dyslipidemia (31.3% vs 28.9, p=0.015), chronic kidney disease (11.6 vs 5%, p=0.029) and CAD (32.7 vs 22.9%, p=0.049).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">There were no significant differences in ACS type, LVEF, KK class, </span></span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">hs-TnI and NT-proBNP levels.</span></span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d"> Group B had a higher prevalence of 3 vessel disease (26.9 vs 17.6%, p=0.045) while 1 vessel disease was more common in gA (48.9 vs 37.9%, p=0.05). </span></span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">There was a higher tendency for arrythmias within 48h of ACS in gA (22.2 vs 13.6%, p=0.045). In-hospital mortality was similar between the groups (gA 3.9 vs gB 3.4%, p=0.816).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">During a median follow-up time of 18 (0-25) months, 27 </span></span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">deaths were verified. Mortality was not statistically different between the groups (gA 10.6 vs gB 6.5%, p= 0.816). Readmissions due to ACS (gA 2.3 vs gB 6.4%, p=0.073) and CVD (gA 9.9 vs gB 12.2%, p=0.477) were also similar in both groups.</span></span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Conclusions: </span></span></span></strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">This study suggests that, although lipoprotein(a) is a well-known risk factor for CAD development, a single measurement above the cut-off of 30 mg/dL may not be associated with a poorer long-term cardiovascular prognosis in pts with AMI. Further studies are needed to provide robust data and reliable recommendations on this theme. </span></span></span></span></span></p>