Relation Between Lipoprotein (a) And Coronary Artery Atherosclerosis, Left Ventricular Performance In Survivors Of Acute Myocardial Infarction

Objective: Previous studies have reported that high plasma lipoprotein(a) [Lp(a)] levels may be responsible for total occlusion of the infarct-related artery (IRA) during acute myocardial infarction (AMI). We evaluated the influence of Lp(a) on coronary artery lesion and left ventricular performance, by analyzing Lp(a) levels, echocardiographic data and coronary angiography findings in AMI patients.Methods: We performed a retrospective analysis of 102 AMI patients who underwent biochemical investigations, echocardiography and coronary angiography. According to the levels of serum Lp(a), all patients were divided into two groups: the low Lp(a) group (< 300 mg/L) and the high Lp(a) group (≧300 mg/L). The clinical, biochemical, echocardiographic data and coronary angiography findings were compared between the low Lp(a) group and the high Lp(a) group.Results:1. There were no differences between the two groups in the levels of other lipoproteins, fasting plasma glucose and clinical background factors ( P>0.05 ). But the plasma concentration of fibrinogen in the high Lp(a) group was significantly higher than that of the low Lp(a) group (4.82±1.43 vs 3.94±1.12 g/L; P<0.05 ).2. The stenosis score of coronary atherosclerosis, the residual stenosis and the occluded rate of the IRA were higher in the high Lp(a) group compared to the low Lp(a) group (11.0±5.4 vs 8.6±4.5, 91.6±8.4 vs 85.9±15.5%, 36.8 vs 15.6%; all P<0.05 ). And antegrade TIMI flow in the IRA was lower in the high Lp(a) group compared to the low Lp(a) group (1.8±1.5 vs 2.5±1.1; P<0.05 ). Localization of the IRA did not show significance in the two groups ( P>0.05 ).3. No significant differences were observed in the left ventricular internal diameter at end-diastole and left ventricular internal diameter at end-systole in the two groups. But regional wall motion score index was higher and global ejection fraction was lower in the high Lp(a) group compared to the low Lp(a) group (1.4±0.3 vs 1.3±0.2, 47.4±13.0 vs 53.8±13.3%; all P<0.05 ).4. Lp(a) concentration was correlated with the levels of plasma fibrinogen and the stenosis score of coronary atherosclerosis. Lp(a) concentration has no relationship to other lipoproteins and the residual stenosis of the IRA. 5. Multiple regression analysis showed that elevated plasma lipoprotein(a) level played an important role in coronary atherosclerosis and three-vessel disease.Conclusion: Serum lipoprotein(a) have a strong relationship with coronary atherosclerosis in patients with acute myocardial infarction. Elevated Lp(a) levels affect the residual stenosis, antegrade TIMI flow, the occluded rate of the infarct-related artery, resulting in a greater extent of abnormal wall motion and a lower ejection fraction. And ultimately left ventricular function was impaired.