Association of lipoprotein(a) with ischemia–reperfusion injury in patients with ST-elevation myocardial infarction

Abstract Background Hypercholesterolemia adversely affects ischemia–reperfusion injury in acute ST-elevation myocardial infarction (STEMI). Lipoprotein(a) (Lp(a)) is an independent cardiovascular risk factor beyond traditional lipid markers; however, its impact on ischemic myocardial injury remains unclear. We therefore investigated the association of Lp(a) with myocardial and microvascular damage assessed by multiparametric cardiovascular magnetic resonance (CMR), as well as clinical outcomes in STEMI patients. Methods and Results In this prospective MARINA-STEMI (NCT04113356) cohort study, 518 STEMI patients (median age 59 years, 19% female) treated with primary percutaneous coronary intervention (PCI) were included. Lp(a) and lipid parameters, including low-density lipoprotein (LDL) cholesterol, were measured at hospital admission. CMR was performed at a median of 4 days (interquartile range (IQR) 3–5) and 4 months (IQR 4–5) after PCI. The primary objective was to assess the association of Lp(a) with infarct size (IS) and severe microvascular injury, defined as intramyocardial hemorrhage (IMH) on baseline CMR. The clinical endpoint was major adverse cardiovascular events (MACE: all-cause death, re-infarction, or new congestive heart failure). Median Lp(a) and LDL cholesterol levels were 27 nmol/l (IQR 20–90) and 141 mg/dl (IQR 117–166), respectively. LDL cholesterol correlated with IS at baseline ( ρ = 0.114, p = 0.010) and was higher in patients with IMH (145 vs. 140 mg/dl, p = 0.031). In contrast, Lp(a) showed no correlation with IS ( ρ = 0.051, p = 0.246) and no association with IMH (25 vs. 28 nmol/l, p = 0.632). Elevated Lp(a) (≥ 105 nmol/l) was not associated with MACE (8.7% vs. 8.8%, p = 0.966). Conclusions While LDL cholesterol was significantly associated with IS and IMH, Lp(a) was not related to ischemia–reperfusion injury patterns or clinical outcomes in patients with STEMI treated with primary PCI. Graphical abstract "Image missing" Created in https://BioRender.com MACE: composite of all-cause death, myocardial re-infarction and new congestive heart failure after discharge for the index event. Lp(a) concentrations ≥ 105 nmol/l are considered elevated according to current guidelines [1]. CMR = cardiovascular magnetic resonance; IMH = intramyocardial hemorrhage; IS = infarct size; LDL = low-density lipoprotein cholesterol; Lp(a) = lipoprotein(a); LVMM = left ventricular myocardial mass; MACE = major adverse cardiovascular events; pPCI = primary percutaneous coronary intervention; STEMI = ST-elevation myocardial infarction.