High Lp(a) predicts MACE and heart failure after acute myocardial infarction in the NARA-MI registry (Circ J 2026)

Background: Lipoprotein(a) (Lp(a)) is a well-established risk factor for atherosclerotic cardiovascular disease, but its prognostic role after acute myocardial infarction (AMI) remains unclear. This study investigated the association between Lp(a) and major adverse cardiovascular events (MACE), including heart failure (HF) with preserved ejection fraction (HFpEF), in patients with AMI.

Methods And Results: We analyzed 1,235 patients with AMI from the NARA-MI registry who underwent emergency percutaneous coronary intervention and had serum Lp(a) measured at admission. Based on receiver operating characteristic curve analysis, patients were categorized into high (≥24 mg/dL) and low (<24 mg/dL) Lp(a) groups. The primary endpoint was MACE, defined as all-cause death, recurrent AMI, HF hospitalization, or unplanned coronary revascularization. During a median follow-up of 3.6 years, 497 MACE events occurred. The incidence of MACE (48.0% vs. 38.3%; P=0.004) and HF hospitalization (9.3% vs. 5.0%; P=0.008) was significantly higher in the high Lp(a) group. In multivariable Cox regression analysis, high-Lp(a) independently predicted MACE (hazard ratio [HR] 1.41; 95% confidence interval [CI] 1.15-1.73; P=0.001) and HF hospitalization (HR 1.87; 95% CI 1.15-3.04; P=0.016). Among patients with HF, 39.7% were classified as HFpEF.

Conclusions: Elevated Lp(a) is independently associated with adverse cardiovascular outcomes after AMI, particularly HF. Measurement of Lp(a) may improve risk stratification after AMI and help identify patients at high risk of developing HF, including HFpEF.