LIPOPROTEIN(A) AS A RISK PREDICTOR FOR CARDIAC MORTALITY IN PATIENTS WITH ACUTE CORONARY SYNDROMES

Aims Raised lipoprotein(a) concentrations are considered to be a risk factor for atherothrombotic diseases. We examined whether baseline con centrations were a risk factor for an adverse outcome in patients admi tted with acute coronary syndromes. Methods and Results Five hundred a nd nineteen patients admitted with suspected acute coronary syndromes were studied and followed prospectively for a median of 3 years. The p rognostic significance of a baseline lipoprotein(a) concentration of 2 30 mg . dl(-1) or lower for subsequent cardiac death was assessed in p atients with myocardial infarction (266) and unstable angina (197) and compared with other variables in regression models. In patients with myocardial infarction, a baseline lipoprotein(a) concentration of grea ter than or equal to 30 mg . dl(-1) was associated with a 62% increase in subsequent cardiac death compared to the lower concentration group (29.8% vs 18.6%, Log rank P=0.04). In a multivariate regression model a baseline lipoprotein(a) concentration of greater than or equal to 3 0 mg . dl(-1) retained its significance as an independent predictor of cardiac death (P=0.037). In patients with unstable angina, baseline c oncentrations of greater than or equal to 79 mg . dl(-1) were found to be significant predictors of cardiac death in univariate (P=0.021) an d multivariate (P=0.035) regression models. Conclusion Baseline lipopr otein(a) concentrations in patients admitted with acute coronary syndr omes are associated with an increased risk of cardiac death. For patie nts with myocardial infarction a concentration of greater than or equa l to 30 mg . dl(-1) appears appropriate as a risk discriminator; for p atients admitted with unstable angina, however, much lower concentrati ons of lipoprotein(a) appear to be prognostically important.