Predictors of Adverse Long-Term Outcome in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Transluminal Coronary Angioplasty : With Special Reference to the Admission Concentration of Lipoprotein (a)

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The predictive values for long-term outcome in 127 consecutive patients with acute myocardial infarction (AMI) after successful primary percutaneous transluminal coronary angioplasty (PTCA) were prospectively investigated in the present study. The primary endpoint was a composite of cardiac death, nonfatal AMI, and recurrent angina. Follow-up angiography was performed in 120 patients to assess restenosis. The primary endpoint occurred in 21 patients during a follow-up period of 35±24 months. These patients had a higher lipoprotein (a) [Lp (a)] concentration (p=0.0105) and more prevalence of multivessel disease (p=0.0028) than the other patients. The subjects were divided into 2 groups at the 75th percentile Lp (a) value : group A had an Lp (a) concentration ≥47 mg/dl and group B <47 mg/dl. Kaplan-Meier analysis showed a lower cardiac event-free survival rate in group A (p=0.0007) and in patients with multivessel disease (p=0.001). In Cox proportional hazards regression analysis, an Lp (a) level ≥47 mg/dl (relative risk [RR] 5.5, 95% confidence interval [CI] 2.0-15.0, p=0.0007) and multivessel disease (RR 5.3, 95% CI 2.0-13.7, p=0.0006) were independent predictors of the primary endpoint. An elevated Lp (a) concentration on admission and multivessel disease are significant predictors for long-term adverse outcome in AMI patients treated by primary PTCA. (Circ J 2003 ; 67 : 605-611)
社団法人日本循環器学会の論文
2003-06-20