Initial decrease in the lipoprotein(a) level is a novel prognostic biomarker in patients with acute coronary syndrome

Table 1 Characteristics of study subjects and baseline data

Variable	Unit	Value
Age	yr	66.6 ± 12.6
Sex (men/women)	%	196/53 (79.0/21.0)
Medical history
Myocardial infarction	%	11 (4.4)
Unstable angina pectoris	%	5 (2.0)
Angina pectoris	%	30 (12.0)
Atrial fibrillation	%	14 (5.6)
Cerebral infarction	%	17 (6.8)
Diabetes mellitus	%	84 (33.7)
Hypertension	%	149 (59.8)
Smoking	%	131 (52.6)
Medication
Calcium channel blocker	%	107 (43.0)
ACE-I/ARB	%	81 (32.5)
Beta blocker	%	22 (8.8)
Loop diuretics	%	20 (8.0)
Nitrates	%	37 (14.9)
Statin	%	67 (26.9)
Fibrate	%	5 (2.0)
Ezetimibe	%	1 (0.4)
Insulin	%	12 (4.8)
SGLT2 inhibitor	%	2 (0.8)
Biguanide	%	8 (3.2)
DPP4 Inhibitor	%	18 (7.2)
BMI	kg/m2	23.8 ± 3.9
Systolic blood pressure	mmHg	134.0 ± 32.0
Heart rate	bpm	77.0 ± 22.0
Laboratory data
Hemoglobin	mg/dL	13.4 ± 2.0
Glucose	mg/dL	190.2 ± 91.3
Hemoglobin A1c	%	6.5 ± 1.3
Total cholesterol	mg/dL	189.0 ± 41.1
Triglyceride	mg/dL	118.81 ± 76.31
LDL-cholesterol	mg/dL	122.4 ± 36.6
non-HDL cholesterol	mg/dL	146.2 ± 40.0
BNP	pg/mL	278.9 ± 1288.0
Creatinine	IU/L	1.2 ± 1.6
Alanine aminotransferase	IU/L	58.5 ± 306.5
peak CK	IU/L	2973.0 ± 3257.0
peak CK-MB	IU/L	300.0 ± 668.0

Values are the number of subjects in each category with percent proportion in parentheses [n (%)] or data expressed as mean ± SD. ACEI: Angiotensin-converting enzyme inhibitor; ARB: Angiotensin II receptor blocker; BMI: Body mass index; BNP: Brain natriuretic peptide; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; CK-MB: Creatine kinase-myocardial isoform; DPP-4: Dipeptidyl peptidase-4; SGLT2: Sodium glucose cotransporter-2.

Table 2 Changes over time in the lipoprotein(a), high-sensitivity C-reactive protein, creatine kinase, and creatine kinase-myocardial isoform from pre-percutaneous coronary intervention to 48 h after percutaneous coronary intervention

	Baseline	3 h	6 h	12 h	24 h	48 h	ANOVA2
Lp(a), mg/dL	19.0 ± 21.8	18.0 ± 20.6b	18.0 ± 20.7b	17.8 ± 20.1b	18.2 ± 19.4a	19.3 ± 19.2	< 0.001
hs-CRP1, ng/mL	9584.4 (511.0, 4745.0)	9784.1 (405.0, 5668.0)	11295.9 (631.0, 7420.0)	16680.2 (1730.0, 14700.0)b	34628.8 (6720.0, 47200.0)b	57233.6 (14400.0, 82600.0)b	< 0.001
CK1, IU/L	567.1 (112.0, 594.0)	2410.3 (478.0, 3403.0)b	2606.7 (579.0, 3893.0)b	2228.0 (617.0, 3193.0)b	1451.6 (454.0, 1918.0)b	625.3 (200.0, 711.0)	< 0.001
CK-MB1, IU/L	53.1 (10.0, 57.0)	221.1 (40.0, 309.0)b	234.6 (54.0, 360.0)b	176.8 (47.0, 261.0)b	81.4 (26.0, 104.0)	21.8 (10.0, 26.0)a	< 0.001

^aP < 0.05.

^bP < 0.01 vs baseline value.

¹Due to skewed distribution, medians (25%, 75% tile) are shown.

²All P values remained the same when age (10-year age group) or sex was included as a covariate (ANCOVA).

CK: Creatine kinase; CK-MB: Creatine kinase MB; hs-CRP: High-sensitivity C-reactive protein; PCI: Percutaneous coronary intervention.

Table 3 Univariate and multivariate analyses to predict major adverse cardiac events

Variable	Univariate cox regression			Multivariate cox regression (model-1)			Multivariate cox regression (model-2)
	HR	95%CI	P value	HR	95%CI	P value	HR	95%CI	P value
Lp(a)Δ0-12	0.96	0.93 to 0.99	0.024a	0.95	0.91 to 0.99	0.022a	0.96	0.92 to 0.99	0.019a
Lp(a) 0 h (baseline)	1.00	0.99 to 1.01	0.960	1.00	0.99 to 1.01	0.503	1.00	0.98 to 1.01	0.956
Age	0.99	0.98 to 1.01	0.481	1.00	0.98 to 1.01	0.833	1.00	0.98 to 1.01	0.721
Sex	1.50	0.97 to 2.33	0.068	1.46	0.89 to 2.37	0.131	1.50	0.94 to 2.40	0.091
Smoking	1.19	0.85 to 1.65	0.305	1.05	0.71 to 1.55	0.803
Diabetes mellitus	1.28	0.91 to 1.79	0.155	1.09	0.72 to 1.65	0.676
Systolic blood pressure	1.00	0.99 to 1.00	0.576	1.00	0.99 to 1.00	0.774
Pulse rate	1.07	0.97 to 1.19	0.192	1.06	0.93 to 1.21	0.388
Hemoglobin A1c	0.99	0.97 to 1.01	0.184	0.99	0.98 to 1.01	0.359
HDL cholesterol	1.00	0.99 to 1.00	0.561	1.00	0.99 to 1.00	0.795
LDL cholesterol	1.01	1.00 to 1.01	0.054
Peak CK-MB	1.00	0.99 to 1.00	0.056				1.00	1.00 to 1.00	0.447
Creatinine	1.16	1.09 to 1.24	< 0.001b				1.13	1.05 to 1.22	< 0.01b
Killip classification	1.50	1.06 to 2.13	0.021a				1.39	0.96 to 2.02	0.078

^aP < 0.05.

^bP < 0.01.

Lp(a): Lipoprotein(a); CK-MB: Creatine kinase-myocardial isoform; MACE: Major adverse cardiovascular events; 95%CI: 95% confidence interval; HR: Hazard ratio.

Table 4 Number of types of major adverse cardiac events during the follow-up period

Event	Total	Within 1 wk	1 wk to 1 month	1-6 months	6-12 months	After 12 months
Cardiac death	13	2	4	4	1	2
Other death	4	2	0	1	0	1
Nonfatal STEMI	2	1	0	0	0	1
Unstable angina	5	0	0	3	0	2
TLR or new PCI	102	0	5	42	36	19
New lesion with ischemia	9	0	1	2	1	5
Nonfatal stroke	7	1	0	1	1	4
EVT for PAD	2	0	0	0	2	0

EVT: Endovascular therapy; PAD: Peripheral artery disease; PCI: Percutaneous coronary intervention; STEMI: ST elevation myocardial infarction; TLR: Target lesion revascularization.