| 조재영, 정명호, 안영근, 홍영준, 박형욱, 윤남식, 윤현주, 김계훈, 김주한, 조정관, 박종춘, 강정채, 박옥규 |
Background: The aim of this study was to assess clinical and laboratory characteristics according to Lp(a) levels combined with apoB/apoA-I ratio and its effect on outcome after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction. Methods: Between Oct 2005 to Jun 2007, we measured serum Lp(a), ApoB and ApoA-I level in 835 consecutive AMI patients (62.7±12.4 years, 602 men) on admission before PCI. We divided patients into four groups according to Lp(a) levels and apoB/apoA-I ratio [Group I: Lp(a) <21.3 mg/dL & apoB/apoA-I ratio <0.771, Group II: Lp(a) ≥21.3 mg/dL & apoB/apoA-I ratio <0.771, Group III: Lp(a) <21.3 mg/dL & apoB/apoA-I ratio ≥0.771, Group IV: Lp(a) ≥21.3 mg/dL & apoB/apoA-I ratio ≥0.771]. Results: The number of ST-depression in EKG tended to increase with higher level of Lp(a) and ApoB/A-I (11.1 vs. 15.1 vs. 17.3 vs. 25.1%, p<0.001). The higher Lp(a) level and ApoB/A-I ratio increase, the more vessels were involved (p=0.007). In analysis of lipid profiles, total cholesterol (164.2±35.3 vs. 163.9±31.7 vs. 192.9±36.1 vs. 200.6±42.4 mg/dL, p<0.001) and LDL-cholesterol (99.7±29.6 vs. 100.4±27.1 vs. 134.3±30.5 vs. 141.5±36.0, p<0.001) tended to be significantly higher in group IV. In analysis of clinical outcomes, all-cause mortality was significantly higher in group IV (7.0 vs. 9.3 vs. 8.3 vs. 13.7%, p=0.032). There was significant difference in recurrent MI among groups (0.5 vs. 0.0 vs. 1.2 vs. 2.4 %, p=0.033). Group I showed significantly higher rate of TLR (10.0 vs. 6.6 vs. 4.1 vs. 3.3 %, p=0.003). In Cox proportional hazard regression analysis, there were no significant differences in composite MACE and all-cause mortality, but patients in group I had 2.7 times more risk of TLR than group IV [RR 2.651, 95% CI 1.008-6.972, p=0.048]. Other risk factors, such as gender difference (p=0.357), using bare-metal stents (p=0.065), LDL-cholesterol level (p=0.518) and triglyceride level (p=0.137) were adjusted. Conclusion: Low serum Lp(a) accompanied with low apoB/apoA-I ratio turned out to be only a independent predictor for TLR after PCI in patients with AMI.
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