Utility of Lipoprotein-Associated Phospholipase A(2) 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 A(2) (Lp-PLA(2)) has been suggested as an inflammatory marker of cardiovascular risk. The predictive value of Lp-PLA(2) 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-PLA(2) 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-PLA(2) 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-PLA(2) cut-off level for the prediction of MACE. The patients were divided into two groups according to the cut-off Lp-PLA(2) level: high Lp-PLA(2) group (>= 463 ng/mL, n = 33) and low Lp-PLA(2) group ( lt 463 ng/mL, n = 67). MACE was defined as cardiac death, non-fatal reinfarction, and target vessel revascularization. Results: Patients in the high Lp-PLA(2) group had significantly higher total-, LDL-cholesterol, apolipoprotein B levels, and significantly lower estimated glomerular filtration rates compared with the low Lp-PLA(2) group. The incidence of 30-day mortality was 18.2% (6/33) in high Lp-PLA(2) group, while in the low Lp-PLA(2) group no patient died (p lt 0.001). The 30-day MACE occurred in 24.2% of the high Lp-PLA(2) group and 3% of the low Lp-PLA(2) group (p = 0.001). Multiple logistic regression analysis identified the plasma Lp-PLA(2) 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-PLA(2) level is an independent predictor of 30-day MACE. (Clin. Lab. 2012;58:1135-1144. DOI: 10.7754/Clin.Lab.2012.111102)