| 조재영, , 정명호, 안영근, 홍영준, 박형욱, 윤남식, 윤현주, 김계훈, 김주한, 조정관, 박종춘, 강정채, 박옥규 |
Background: An elevated concentration of lipoprotein (a) [Lp(a)] is associated with an increased prevalence and severity of coronary artery disease (CAD). But the relationship between Lp(a) and outcomes after acute myocardial infarction (AMI) is controversial. Methods: Between October 2005 to June 2007, we measured serum Lp (a) level in 736 consecutive AMI patients (62.8±12.4 years, 665 men) on admission. They were divided into three groups and each group had almost same number of patients[Group I: Lp (a)<13.8 mg/dL, Group II: 13.8≤Lp(a)<30.6, Group III: Lp(a)≥30.6 mg/dL].
Results: The baseline clinical characteristics among three groups showed no significant difference in age (61.7±12.5 vs. 62.2±12.6 vs. 64.1±12.0, p=0.059), sex ( 209 men vs. 197 men vs. 194 men, p=0.136) and BMI (24.1±2.9 vs. 24.2±3.4 vs. 24.0±3.1, p=0.707). In analysis of past history, there were no differences among three groups in hypertension (44.5% vs. 43.9% vs. 48.4%, p=0.367), diabetes mellitus (28.1% vs. 26.0% vs. 29.2%, p=0.775), dyslipidemia (2.5% vs. 5.7% vs. 3.6%, p=0.519), smoking (68.1% vs. 61.6% vs. 60.3%, p=0.056) and family history (2.2% vs. 5.0% vs. 5.4%, p=0.058). But, there are significant differences in number of deployed stents (Group II: 1.52 vs. Group III: 1.78, p=0.011) and left ventricular ejection fraction (LVEF)(Group I: 57.3±11.4% vs. Group III: 53.1±13.1%, p<0.001). In laboratory findings, we could find significant difference in total cholesterol levels (group I: 173.3±37.2 mg/dL vs. group III: 185.3±43.8 mg/dL, p=0.001), low density lipoprotein cholesterol levels (Group I: 111.3±34.3 vs. Group III: 123.3±39.4 mg/dL, p<0.001), Apo B/ A-I ratio (Group I: 0.74±0.25 vs. Group III: 0.83±0.27, p<0.001) and NT Pro-BNP (Group I: 1805.2±4343.3 vs. Group III: 3981.5±7689.7 pg/mL, p<0.001). In patients with ST-elevation myocardial infarction, In patients with ST-elevation myocardial infarction. MACE-free survival was higher in Group III than Group I (p=0.018) at 1-year follow-up. Conclusion: High Lp(a) level is significantly associated with long-term adverse outcomes after ST-elevation myocardial infarction and thus, we need to treat patients aggressively with high initial Lp (a) levels.
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