Lp(a) and an LDL subfraction synergistically predict MACE after ACS, cohort of 2,061 (Angiology 2026)

The present study aimed to investigate the combined impact of lipoprotein (a) [Lp(a)] and low-density lipoprotein (LDL) subfractions on cardiovascular outcomes in patients with acute coronary syndrome (ACS). The study enrolled 2061 ACS patients from Tianjin Chest Hospital. Participants were categorized into 4 groups based on their Lp(a) and the concentration of the sixth component particles of LDL(LDL-P6). The primary endpoint was the occurrence of major adverse cardiovascular events (MACE). The relationship between LDL-P6, Lp(a), and MACE was evaluated. Over a mean follow-up period of 5.4 years, 456 (22.1%) patients experienced MACE. Multivariate analysis identified both LDL-P6 and Lp(a) as significant independent predictors of MACE in ACS patients. Those in the highest-risk group had a substantially higher incidence of MACE compared with the lowest-risk group (HR 5.718; 95% CI 3.703-8.829; P < .001). The area under the curve (AUC) for MACE prediction was 0.735 for Lp(a) and 0.727 for LDL-P6. Adding either biomarker to baseline models significantly improved the C-statistic and integrated discrimination improvement (all P < .001). In ACS patients, both Lp(a) and LDL-P6 independently and synergistically predicted MACE, underscoring the value of incorporating these markers into risk stratification models for more accurate patient assessment.