High Lp(a) predicts worse long-term outcomes after STEMI in Japanese patients, 868-patient cohort (Circ J 2026)

Original title: Prognostic Value of Serum Lipoprotein(a) Levels in Japanese Patients With ST-Segment Elevation Myocardial Infarction

Circ J · 7 March 2026 · 6

Nishiyama K, Nishihira K, Nakai M, Baba K, Takamatsu M, Honda Y, Yamamoto K, Nishino S, Kadooka K, Kudo T, Ogata K, Kimura T et al.

Retrospective cohort of 868 consecutive Japanese patients with ST-segment elevation myocardial infarction (STEMI), median serum Lp(a) 15.75 mg/dL at admission and median follow-up 736.5 days. Using a restricted cubic spline-derived cutoff of 47.26 mg/dL, the high-Lp(a) group was older, more often female, and had lower body weight, eGFR and stent use, with higher dyslipidaemia prevalence. The 5-year cumulative incidence of the composite endpoint (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke or any revascularisation) was significantly higher with high Lp(a), driven mainly by more revascularisation. After adjustment, high Lp(a) remained an independent predictor of the composite endpoint (hazard ratio 1.932, 95% CI 1.255-2.974).

Original abstract

Background: Because the prognostic value of lipoprotein(a) [Lp(a)] levels in Japanese patients remains unclear, we assessed their distribution and association with long-term outcomes in ST-segment elevation myocardial infarction (STEMI).

Methods And Results: In our retrospective analysis of 868 consecutive patients with STEMI, the median serum Lp(a) level was 15.75 mg/dL at admission, and the median follow-up was 736.5 days. Using restricted cubic spline analysis, we stratified patients into high (≥47.26 mg/dL) and low (<47.26 mg/dL) Lp(a) groups. The high Lp(a) group had a higher proportion of older and female patients, with lower body weight, estimated glomerular filtration rate, and stent use, and higher dyslipidemia prevalence than those in the low Lp(a) group. The 5-year cumulative incidence of the composite primary endpoint (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or any revascularization) was significantly higher in the high Lp(a) group, primarily because of a high rate of any revascularization. Patients with elevated Lp(a) levels demonstrated higher rates of any revascularization for both de novo and restenotic lesions than those with lower levels. After adjusting for confounders, a high Lp(a) level was identified as an independent predictor of the primary endpoint (hazard ratio:1.932; 95% confidence interval:1.255-2.974).

Conclusions: In Japanese patients with STEMI, elevated Lp(a) levels were independently associated with worse long-term outcomes.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.