Association of lipoprotein(a) with coronary severity in patients with new-onset acute myocardial infarction: A large cross-sectional study

Abstract

Background: Although current evidence suggests a causal association between lipoprotein(a) [Lp(a)] and cardiovascular disease, there is still no consensus on its association with coronary severity in new-onset acute myocardial infarction (AMI). We explored the association of Lp(a) with coronary severity.

Methods: In this large cross-sectional study, we enrolled 2,740 patients with new-onset AMI from the Zhongda Hospital affiliated to Southeast University. Lp(a) was considered as an exposure variable. Gensini score, left main disease and three-vessel disease were used to assess coronary severity. Multivariate logistic regression, restricted cubic spline (RCS) models and threshold effects were used to analyze the association of Lp(a) with coronary severity.

Results: Multivariate adjusted models showed that Lp(a) was independently associated with Gensini score (≥100), left main disease and three-vessel disease [Q4 vs Q1, OR (95 % CI), P value: 2.301 (1.770, 2.992), P < 0.001; 1.743 (1.174, 2.587), P = 0.006; 1.431 (1.128, 1.816), P = 0.003; respectively], and the associations persisted in sensitivity analyses and most subgroups (P < 0.05). Additionally, the RCS showed that Lp(a) was nonlinearly associated with Gensini score (continuous variable), Gensini score (≥100) and three-vessel disease (P for nonlinearity < 0.05). Threshold effects analysis showed that Lp(a) above the inflection point was positively associated with Gensini score (continuous variable) as well as the risk of Gensini score (≥100) and three-vessel disease.

Conclusion: Lp(a) was closely associated with coronary severity represented by Gensini score, left main disease and three-vessel disease in patients with new-onset AMI.

Keywords: Acute myocardial infarction; Coronary severity; Gensini score; Left main disease; Lipoprotein(a); Three-vessel disease.