High Lipoprotein(a) Is a Predictor of Adverse Events and Heart Failure in Patients With Acute Myocardial Infarction
Abstract
BACKGROUND: Lipoprotein(a) (Lp(a)) is a well-established risk factor for atherosclerotic cardiovascular disease, but its prognostic role after acute myocardial infarction (AMI) remains unclear. This study investigated the association between Lp(a) and major adverse cardiovascular events (MACE), including heart failure (HF) with preserved ejection fraction (HFpEF), in patients with AMI. METHODS AND RESULTS: We analyzed 1,235 patients with AMI from the NARA-MI registry who underwent emergency percutaneous coronary intervention and had serum Lp(a) measured at admission. Based on receiver operating characteristic curve analysis, patients were categorized into high (≥24 mg/dL) and low (<24 mg/dL) Lp(a) groups. The primary endpoint was MACE, defined as all-cause death, recurrent AMI, HF hospitalization, or unplanned coronary revascularization. During a median follow-up of 3.6 years, 497 MACE events occurred. The incidence of MACE (48.0% vs. 38.3%; P=0.004) and HF hospitalization (9.3% vs. 5.0%; P=0.008) was significantly higher in the high Lp(a) group. In multivariable Cox regression analysis, high-Lp(a) independently predicted MACE (hazard ratio [HR] 1.41; 95% confidence interval [CI] 1.15-1.73; P=0.001) and HF hospitalization (HR 1.87; 95% CI 1.15-3.04; P=0.016). Among patients with HF, 39.7% were classified as HFpEF. CONCLUSIONS: Elevated Lp(a) is independently associated with adverse cardiovascular outcomes after AMI, particularly HF. Measurement of Lp(a) may improve risk stratification after AMI and help identify patients at high risk of developing HF, including HFpEF.
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BibTeX
@article{wang2026high,
title = {{High Lipoprotein(a) Is a Predictor of Adverse Events and Heart Failure in Patients With Acute Myocardial Infarction}},
author = {Yang Wang and Tomoya Ueda and Akihiko Okamura and Saki Nobuta and Atsushi Kyodo and Yasuki Nakada and Yukihiro Hashimoto and Hitoshi Nakagawa and Taku Nishida and Kenji Onoue and Shungo Hikoso},
journal = {Circulation Journal},
year = {2026},
month = oct,
doi = {10.1253/circj.cj-26-0268},
url = {https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-26-0268/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - High Lipoprotein(a) Is a Predictor of Adverse Events and Heart Failure in Patients With Acute Myocardial Infarction
AU - Yang Wang
AU - Tomoya Ueda
AU - Akihiko Okamura
AU - Saki Nobuta
AU - Atsushi Kyodo
AU - Yasuki Nakada
AU - Yukihiro Hashimoto
AU - Hitoshi Nakagawa
AU - Taku Nishida
AU - Kenji Onoue
AU - Shungo Hikoso
PY - 2026
DA - 2026/10/16
JO - Circulation Journal
DO - 10.1253/circj.cj-26-0268
UR - https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-26-0268/_article
AB - BACKGROUND: Lipoprotein(a) (Lp(a)) is a well-established risk factor for atherosclerotic cardiovascular disease, but its prognostic role after acute myocardial infarction (AMI) remains unclear. This study investigated the association between Lp(a) and major adverse cardiovascular events (MACE), including heart failure (HF) with preserved ejection fraction (HFpEF), in patients with AMI. METHODS AND RESULTS: We analyzed 1,235 patients with AMI from the NARA-MI registry who underwent emergency percutaneous coronary intervention and had serum Lp(a) measured at admission. Based on receiver operating characteristic curve analysis, patients were categorized into high (≥24 mg/dL) and low (<24 mg/dL) Lp(a) groups. The primary endpoint was MACE, defined as all-cause death, recurrent AMI, HF hospitalization, or unplanned coronary revascularization. During a median follow-up of 3.6 years, 497 MACE events occurred. The incidence of MACE (48.0% vs. 38.3%; P=0.004) and HF hospitalization (9.3% vs. 5.0%; P=0.008) was significantly higher in the high Lp(a) group. In multivariable Cox regression analysis, high-Lp(a) independently predicted MACE (hazard ratio [HR] 1.41; 95% confidence interval [CI] 1.15-1.73; P=0.001) and HF hospitalization (HR 1.87; 95% CI 1.15-3.04; P=0.016). Among patients with HF, 39.7% were classified as HFpEF. CONCLUSIONS: Elevated Lp(a) is independently associated with adverse cardiovascular outcomes after AMI, particularly HF. Measurement of Lp(a) may improve risk stratification after AMI and help identify patients at high risk of developing HF, including HFpEF.
SN - 1347-4820
SN - 1346-9843
ER -