title: Utility of lipoprotein-associated phospholipase A2 for prediction of 30-day major adverse coronary event in patients with the first anterior ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention.
abstract: BACKGROUND
  Lipoprotein-associated phospholipase A2 (Lp-PLA2) has been suggested as an inflammatory marker of cardiovascular risk. The predictive value of Lp-PLA2 in ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI) has not been established. The aim of this study was to determine whether plasma Lp-PLA2 is a predictor of a major adverse cardiac event (MACE) in patients with the first anterior STEMI treated by primary PCI.
  
  
  METHODS
  This study consisted of 100 consecutive patients with first anterior STEMI who underwent primary PCI within 6 hours of the symptom onset. Plasma Lp-PLA2 level was measured on admission using a turbidimetric immunoassay (diaDexus, Inc., USA). The Receiver Operating Characteristic analysis was performed to identify the most useful Lp-PLA2 cut-off level for the prediction of MACE. The patients were divided into two groups according to the cut-off Lp-PLA2 level: high Lp-PLA2 group (> or = 463 ng/mL, n = 33) and low Lp-PLA2 group (< 463 ng/mL, n = 67). MACE was defined as cardiac death, non-fatal reinfarction, and target vessel revascularization.
  
  
  RESULTS
  Patients in the high Lp-PLA2 group had significantly higher total-, LDL-cholesterol, apolipoprotein B levels, and significantly lower estimated glomerular filtration rates compared with the low Lp-PLA2 group. The incidence of 30-day mortality was 18.2% (6/33) in high Lp-PLA2 group, while in the low Lp-PLA2 group no patient died (p < 0.001). The 30-day MACE occurred in 24.2% of the high Lp-PLA2 group and 3% of the low Lp-PLA2 group (p = 0.001). Multiple logistic regression analysis identified the plasma Lp-PLA2 level as an independent predictor of MACE (OR 1.011, 95%CI 1.001 - 1.013, p = 0.037).
  
  
  CONCLUSIONS
  In patients with first anterior STEMI treated by primary PCI, the plasma Lp-PLA2 level is an independent predictor of 30-day MACE.
authors.affiliation: Center for Medical Biochemistry, School of Pharmacy, University of Belgrade, Clinical Center of Serbia, Belgrade, Serbia. sanjast@eunet.rs
authors.forename: Sanja
authors.initials: S
authors.lastname: Stankovic
authors.forename: Milika
authors.initials: M
authors.lastname: Asanin
authors.forename: Danijela
authors.initials: D
authors.lastname: Trifunovic
authors.forename: Nada
authors.initials: N
authors.lastname: Majkic-Singh
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Miljković
authors.forename: Svetlana
authors.initials: S
authors.lastname: Ignjatovic
authors.forename: Igor
authors.initials: I
authors.lastname: Mrdovic
authors.forename: Dragan
authors.initials: D
authors.lastname: Matic
authors.forename: Lidija
authors.initials: L
authors.lastname: Savic
authors.forename: Miodrag
authors.initials: M
authors.lastname: Ostojic
authors.forename: Zorana
authors.initials: Z
authors.lastname: Vasiljevic
mesh_terms: D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase / Q000097:blood*; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000503:physiopathology*
chemical_list: D015415:Biomarkers; D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase