Prognostic Value of Lipoprotein (a) in Japanese Patients with Acute Coronary Syndrome Surviving Primary Percutaneous Coronary Intervention to Discharge

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute coronary syndrome (ACS) surviving primary percutaneous coronary intervention (PCI) to hospital discharge (n=347). Intervention: Elevated lipoprotein(a) [Lp(a) >= 30 mg/dL] vs. Lp(a) < 30 mg/dL. Primary outcome: Major adverse cardiac events (MACE: composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and congestive heart failure requiring hospitalization) (HR 1.32, 95% CI 0.67-2.60, p=0.43).

Q: What does this research mean for the field?

Elevated lipoprotein(a) levels (≥ 30 mg/dL) do not significantly predict mid-term major adverse cardiac events in Japanese acute coronary syndrome patients surviving primary percutaneous coronary intervention to discharge. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ryo Okubo; Yousuke Komatsu; Daiki Kishigami; Kojiro Sakurai; Masakazu Tsubono; Shojiro Hirano; Yoshimasa Kojima; Hiroto Aikawa; Takayuki Yabe; Hideo Amano; Takanori Ikeda

doi:10.1536/ihj.25-600

July 30, 2026International Heart JournalOpen Access

Prognostic Value of Lipoprotein (a) in Japanese Patients with Acute Coronary Syndrome Surviving Primary Percutaneous Coronary Intervention to Discharge

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Key result

Elevated lipoprotein(a) (>=30 mg/dL) was not significantly associated with mid-term MACE (HR 1.32, 95% CI 0.67-2.60, P=0.43) in Japanese ACS patients surviving primary PCI to discharge.

Why the study?

Previous studies on lipoprotein(a) as a prognostic factor in ACS have yielded conflicting results, with limited data in Japanese populations and inconsistent inclusion of early in-hospital deaths.

Does elevated lipoprotein(a) (>= 30 mg/dL) predict mid-term major adverse cardiac events in Japanese acute coronary syndrome patients surviving primary PCI to hospital discharge?

Key Points

To evaluate whether serum lipoprotein(a) levels predict mid-term major adverse cardiac events in Japanese acute coronary syndrome patients surviving to discharge after primary percutaneous coronary intervention.
Single-center retrospective study of 347 consecutive Japanese patients undergoing successful primary percutaneous coronary intervention between December 2016 and March 2021 who survived to hospital discharge.
Patients were stratified by lipoprotein(a) levels (< 30 mg/dL, n = 275 vs. ≥ 30 mg/dL, n = 72) and followed for a median of 37 months for major adverse cardiac events, comprising all-cause death, nonfatal myocardial infarction, nonfatal stroke, and heart failure hospitalization.
Major adverse cardiac events occurred in 59 patients (17.0%), with no significant difference in event-free survival between patients with lipoprotein(a) < 30 mg/dL and ≥ 30 mg/dL (log-rank P = 0.46) or between < 50 mg/dL and ≥ 50 mg/dL (log-rank P = 0.12).
In multivariable Cox regression models, lipoprotein(a) ≥ 30 mg/dL was not associated with adverse events (Model 1: HR 1.32, 95% CI 0.67–2.60, P = 0.43; Model 2: HR 1.39, 95% CI 0.71–2.74, P = 0.34; Model 3: HR 1.37, 95% CI 0.71–2.67, P = 0.35).
Significant independent predictors of mid-term events were age ≥ 70 years (HR 2.90, 95% CI 1.48–5.70, P = 0.002), male sex (HR 2.17, 95% CI 1.10–4.25, P = 0.03), and chronic kidney disease (HR 3.04, 95% CI 1.68–5.51, P < 0.001).

Study Design

Type

Cohort (n=347)

Multicenter

No

Structured PICO

Does elevated lipoprotein(a) (>= 30 mg/dL) predict mid-term major adverse cardiac events in Japanese acute coronary syndrome patients surviving primary PCI to hospital discharge?

P

Population

347 consecutive Japanese adults with type 1 acute coronary syndrome (mean age 67.0 years, 17.0% female) who underwent successful primary PCI and survived to discharge without mechanical circulatory/ventilatory support, followed for a median of 37 months.

E

Exposure

Elevated baseline serum lipoprotein(a) [Lp(a) >= 30 mg/dL] (n=72), measured in the morning after an overnight fast within 5 days after primary PCI, on background contemporary secondary prevention (96.3% statin use at discharge).

C

Comparator

Low/normal baseline serum lipoprotein(a) [Lp(a) < 30 mg/dL] (n=275), on background contemporary secondary prevention.

O

Outcome

Major adverse cardiac events (MACE), defined as a composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and congestive heart failure requiring hospitalization over a median follow-up of 37 months (IQR 17-55 months).composite

Main Result

Hazard Ratio: 1.32 (95% CI 0.67–2.6)

p-value: p=0.43

Limitations

Single-center, retrospective study with a moderate sample size (n=347) and a limited number of events (n=59), reducing statistical power
Relatively short follow-up period (median 37 months) with declining numbers of patients at risk at later time points
Potential survival bias due to focusing exclusively on patients who survived to hospital discharge and excluding those requiring mechanical support
Comprehensive institutional lifestyle interventions during hospitalization may have attenuated the prognostic impact of Lp(a)
Exclusively Japanese population with relatively low median Lp(a) levels (14 mg/dL), limiting generalizability to other ethnic groups
Single-center, retrospective design with moderate sample size and limited number of events (59 MACE), reducing statistical power
Relatively short follow-up period (median 37 months) with substantial decline in patients at risk at later time points
Potential survival bias from excluding in-hospital deaths and critically ill patients requiring mechanical support
Comprehensive institutional lifestyle interventions may have attenuated the prognostic impact of Lp(a)
Study conducted exclusively in a Japanese population, limiting generalizability to other ethnic groups

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Implication

In Japanese ACS patients surviving primary PCI on contemporary high-rate statin therapy, elevated Lp(a) did not independently predict mid-term MACE, whereas traditional risk factors (age >= 70, male sex, and CKD) remained the primary drivers of prognosis.

Abstract

Previous studies investigating lipoprotein(a) [Lp(a)] as a prognostic factor in acute coronary syndrome (ACS) have yielded conflicting results, with limited data in Japanese populations. Inconsistent inclusion of early in-hospital deaths further limits clinical applicability for secondary prevention strategies.To evaluate the prognostic value of Lp(a) levels in ACS patients who underwent successful primary percutaneous coronary intervention (PCI) and survived to hospital discharge.This single-center retrospective study enrolled 347 consecutive Japanese ACS patients who underwent primary PCI between December 2016 and March 2021 and were discharged alive. Patients were stratified by Lp(a) levels: < 30 mg/dL (n = 275) and ≥ 30 mg/dL (n = 72). The primary endpoint was major adverse cardiac events (MACE), defined as all-cause death, nonfatal myocardial infarction, nonfatal stroke, and heart failure requiring hospitalization. Kaplan-Meier survival analysis and multivariable Cox regression models were performed.During a median follow-up of 37 months, 59 MACE events (17.0%) occurred. The median Lp(a) level was 14 mg/dL. Kaplan-Meier analysis showed no significant difference in MACE-free survival between groups (log-rank P = 0.46). In all multivariable analyses, Lp(a) ≥ 30 mg/dL was not associated with mid-term MACE. Significant predictors were age ≥ 70 years, male sex, and chronic kidney disease.Elevated Lp(a) levels did not significantly predict mid-term MACE in Japanese ACS patients surviving primary PCI. Traditional risk factors, including age, male sex, and chronic kidney disease, were the primary determinants of mid-term prognosis in this population.

Discussion

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Cite This Study

Okubo et al. (2026) conducted a cohort in Acute coronary syndrome (ACS) surviving primary percutaneous coronary intervention (PCI) to hospital discharge (n=347). Elevated lipoprotein(a) [Lp(a) >= 30 mg/dL] vs. Lp(a) < 30 mg/dL was evaluated on Major adverse cardiac events (MACE: composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and congestive heart failure requiring hospitalization) (HR 1.32, 95% CI 0.67-2.60, p=0.43). Elevated lipoprotein(a) (>=30 mg/dL) was not significantly associated with mid-term MACE (HR 1.32, 95% CI 0.67-2.60, P=0.43) in Japanese ACS patients surviving primary PCI to discharge.

synapsesocial.com/papers/6a6eeaa21b0468a7eeab2e74 https://doi.org/10.1536/ihj.25-600

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Prognostic Value of Lipoprotein (a) in Japanese Patients with Acute Coronary Syndrome Surviving Primary Percutaneous Coronary Intervention to Discharge

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Prognostic Value of Lipoprotein (a) in Japanese Patients with Acute Coronary Syndrome Surviving Primary Percutaneous Coronary Intervention to Discharge

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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