Admission lipoprotein-associated phospholipase A2 activity is not associated with long-term clinical outcomes after ST-segment elevation myocardial infarction.
BACKGROUND
Lipoprotein-associated phospholipase A2 (Lp-PLA2) activity is a biomarker predicting cardiovascular diseases in a real-world. However, the prognostic value in patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI) on long-term clinical outcomes is unknown.


METHODS
Lp-PLA2 activity was measured in samples obtained prior to pPCI from consecutive STEMI patients in a high-volume intervention center from 2005 until 2007. Five years all-cause mortality was estimated with the Kaplan-Meier method and compared among tertiles of Lp-PLA2 activity during complete follow-up and with a landmark at 30 days. In a subpopulation clinical endpoints were assessed at three years. The prognostic value of Lp-PLA2, in addition to the Thrombolysis In Myocardial Infarction or multimarker risk score, was assessed in multivariable Cox regression.


RESULTS
The cohort (n = 987) was divided into tertiles (low <144, intermediate 144-179, and high >179 nmol/min/mL). Among the tertiles differences in baseline characteristics associated with long-term mortality were observed. However, no significant differences in five years mortality in association with Lp-PLA2 activity levels were found; intermediate versus low Lp-PLA2 (HR 0.97; CI 95% 0.68-1.40; p = 0.88) or high versus low Lp-PLA2 (HR 0.75; CI 95% 0.51-1.11; p = 0.15). Both in a landmark analysis and after adjustments for the established risk scores and selection of cases with biomarkers obtained, non-significant differences among the tertiles were observed. In the subpopulation no significant differences in clinical endpoints were observed among the tertiles.


CONCLUSIONS
Lp-PLA2 activity levels at admission prior to pPCI in STEMI patients are not associated with the incidence of short and/or long-term clinical endpoints. Lp-PLA2 as an independent and clinically useful biomarker in the risk stratification of STEMI patients still remains to be proven.
Heart Center, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
Pier
P
Woudstra
Heart Center, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
Peter
P
Damman
Heart Center, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
Wichert J
WJ
Kuijt
Heart Center, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
Wouter J
WJ
Kikkert
Heart Center, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
Maik J
MJ
Grundeken
Heart Center, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
Peter M
PM
van Brussel
Department of Clinical Chemistry, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
An K
AK
Stroobants
Department of Clinical Chemistry, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
Jan P
JP
van Straalen
Department of Clinical Chemistry, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
Johan C
JC
Fischer
Heart Center, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
Karel T
KT
Koch
Heart Center, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
José P S
JP
Henriques
Heart Center, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
Jan J
JJ
Piek
Heart Center, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
Jan G P
JG
Tijssen
Heart Center, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
Robbert J
RJ
de Winter
D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase / Q000097:blood*; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000201:enzymology* / Q000401:mortality* / Q000601:surgery; D010343:Patient Admission; D062645:Percutaneous Coronary Intervention; D016896:Treatment Outcome
D015415:Biomarkers; D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase; C526684:PLA2G7 protein, human