The Relationship between the Levels of Lipoprotein (a) and Fibrinogen and Clinical Outcome in Patients with Acute Myocardial Infarction

Su Hyun Kim; Myung Ho Jeong; Min Goo Lee; Jum Suk Ko; Keun-Ho Park; Doo Sun Sim; Young Joon Hong; Ju Han Kim; Youngkeun Ahn; Jung Chaee Kang

doi:10.4068/cmj.2010.46.1.38

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Kim, Jeong, Lee, Ko, Park, Sim, Hong, Kim, Ahn, and Kang: The Relationship between the Levels of Lipoprotein (a) and Fibrinogen and Clinical Outcome in Patients with Acute Myocardial Infarction

Original Article

Chonnam Medical Journal

Chonnam Medical Journal 2010; 46(1): 38-43.

Published online: 15 April 2010

DOI: https://doi.org/10.4068/cmj.2010.46.1.38

The Relationship between the Levels of Lipoprotein (a) and Fibrinogen and Clinical Outcome in Patients with Acute Myocardial Infarction

Su Hyun Kim, Myung Ho Jeong, Min Goo Lee, Jum Suk Ko, Keun-Ho Park, Doo Sun Sim, Young Joon Hong, Ju Han Kim, Youngkeun Ahn, Jung Chaee Kang

The Heart Center of Chonnam National University Hospital, Heart Research Center of Chonnam National University Hospital Designated by Korea Ministry of Health, Welfare and Family Affairs, Gwangju, Korea.

Corresponding author (myungho@chollian.net)

Received 4 February 2010 Accepted 7 February 2010

Abstract

The aim of this study was to evaluate clinical outcomes in patients with acute myocardial infarction (AMI) on the basis of serum levels of lipoprotein (a) [Lp(a)] and fibrinogen. A total of 537 consecutive patients (62.4±12.3 years) diagnosed with AMI between January 2006 and December 2007 were divided into four groups according to serum levels of Lp(a) and fibrinogen on admission [group I: normal Lp(a) and normal fibrinogen levels (n=235); group II: elevated Lp(a) and normal fibrinogen levels (n=100); group III: normal Lp(a) and elevated fibrinogen levels (n=105); group IV: elevated Lp(a) and elevated fibrinogen levels (n=95)]. The baseline clinical characteristics showed significant differences between the four groups in age (p<0.001), body mass index (p=0.025), N-terminal pro-brain natriuretic peptide levels (p<0.001), left ventricular ejection fraction (p<0.001), and echocardiographic wall motion scores (p<0.001). In the coronary angiographic findings, the number of diseased vessels was higher?and involvement of the left anterior descending artery was more common in group IV than in group I (1.8±0.9 vs. 1.5±0.8, p=0.001, and 65% vs. 51%, p=0.042, respectively). Likewise, in-hospital and 1-month major adverse cardiac events were more frequent in group IV than in group I (4.2% vs. 1.3%, p=0.037, and 14.1% vs. 3.1%, p<0.001, respectively). In conclusion, AMI patients with high Lp(a) or fibrinogen levels had worse clinical outcomes than did patients with normal levels of Lp(a) and fibrinogen.

Keywords: Lipoproteins, Fibrinogen, Prognosis

Figures and Tables

Table 1

Comparison of clinical and laboratory finding of four groups according to the levels of lipoprotein (a) and fibrinogen

BMI, body mass index; DM, Diabetes mellitus; Lp(a), lipoprotein(a); CK-MB, creatine kinase-MB; TC, total cholesterol; HDL-C, high density lipoproteincholesterol; LDL-C, Low density lipoprotein-cholesterol; hsCRP, high sensitive C-reactive protein; NT-proBNP, N-terminal pro-B-type natriuretic peptide.

Table 2

Comparison of coronary angiographic finding and major adverse cardiac events among four groups

LVEF, left ventricular ejection fraction; LAD, Left anterior descending artery; LCX, Left circumflex artery; RCA, Right coronary artery; PCI, percutaneous coronary intervention; TIMI, Thrombolysis In Myocardial Infarction; ACE, angiotensin converting enzyme: ARB, Angiotensin II Receptor Blocker MACE, major adverse cardiac events.

Table 3

Baseline clinical characteristics between survivors and moribund patients

SBP, systolic blood pressure; DBP, diastolic blood pressure.

Table 4

Univariate predictors of one-year mortality

hsCRP, high sensitive C-reactive protein; NT-proBNP, N-terminal pro-B-type natriuretic peptide LVEF, left ventricular ejection fraction.

Table 5

Cox regression analysis for independent predictors of one-year mortality in the patients with acute myocardial infarction

hsCRP, high sensitive C-reactive protein; LVEF, left ventricular ejection fraction.

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