Variability of lipoprotein(a) levels in patients with acute myocardial infarction between admission, discharge, and follow-up

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Abstract
Aims: Lipoprotein(a) [Lp(a)] is an established risk factor for atherosclerotic cardiovascular disease. Using Lp(a) concentrations measured during stable follow-up as the reference, we aimed to assess the temporal variability of Lp(a) after acute myocardial infarction (AMI) and to explore a pragmatic strategy for Lp(a) measurement. Methods and results: The FRENCHIE-Lp(a) cohort enrolled consecutive adults hospitalized for AMI in 21 centres. Lp(a) mass concentration, measured at admission, hospital discharge, and 3–12 months follow-up, was analysed both as a continuous and predefined categorical variable (≤20, >20–≤50, >50–≤70, >70 mg/dL). Assuming follow-up Lp(a) as the reference, we aimed to identify the threshold values that would allow us to accurately identify patients with Lp(a) > 70mg/dL, the threshold mostly used for patient selection in phase III trials of targeted Lp(a) therapies. A cumulative threshold analysis was performed to identify the Lp(a) value below which the misclassification rate (i.e. % of patients with follow-up Lp(a) > 70 mg/dL) remained 70 mg/dL at follow-up compared to 39.9% of those with discharge-Lp(a) >37 mg/dL. Conclusion: Although the median Lp(a) level remained stable between admission and follow-up, one-third of AMI patients shifted within Lp(a) categories over time. Pending external validation, an exploratory two-step strategy based on Lp(a) measurement at discharge, followed by repeat testing in patients with Lp(a) >37 mg/dL, showed a misclassification rate below 1% for identifying patients potentially needing intervention. Registration: Clinical trial Number: NCT04050956
Funding Information
  • FRENCHIE
  • Assistance Publique
  • Assistance Publique - Hôpitaux de Paris
  • Recherche Hospitalo-Universitaire
  • iVASC (ANR-16-RHUS-00010)
  • Agence Nationale de la Recherche
  • Plan d'Investissement d'Avenir-2
  • Ministry of Health
  • Novartis Pharmaceuticals Corporation

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