الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 106 |  |  |
| | | from | 106 | | |
Abstract
Acute myocardial infarction (AMI), a disease with high-mortality rate, is mainly caused by rupture of vulnerable plaques, formation of thrombosis in coronary arteries and coronary stenosis or occlusion.
Percutaneous coronary intervention (PCI) is the treatment of choice for patients presenting with ST-elevation myocardial infarction (STEMI). Timely PCI is able to reduce infarct size and ventricular dysfunction, thus resulting in better clinical outcomes.
Dyslipidemia is a major risk factor for CHD, and lowering serum low-density lipoprotein cholesterol (LDL-C) level with statins treatment is beneficial to reduce cardiovascular events after percutaneous coronary intervention (PCI) treatment.
Lp (a) is a lipoprotein that contains similar to low density lipoprotein (LDL) apolipoprotein B and in addition apolipoprotein (a) which is attached by a disulfide bridge. Increased Lp (a) plasma concentrations have been associated with increased risk of CHD, interacting with, but independently of other risk factors.
For patients with established stable coronary heart disease, an association of Lp (a) with cardiovascular risk has been inconsistent, and it has been suggested that such an association may depend on a concurrent high concentration of low-density lipoprotein cholesterol.
The effects of increased serum Lp (a) level on clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) have been mainly evaluated in a lot of studies, with mixed results.
The current prospective study was conducted at cardiac care unit at Cardiovascular Departments of Menoufia University, and Sharm El Sheikh International Hospital aiming to evaluate association between Lipoprotein (a) [Lp (a)] and in-hospital outcomes in patients with acute ST elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI)
We included a total of 70 patients who were divided into two groups: -
-group I: - patient with low lipoprotein (a) (<30 mg/dl)
-group II: - patient with high lipoprotein (a) (≥30 mg/dl)
All participants were subjected to history taking, clinical examination,
ECG, and laboratory investigations (including Cardiac biomarkers; Lipoprotein (a) level).
Moreover, primary outcome and secondary outcome were also collected. Our study revealed the following findings:
• There was high statistically significant difference in between the studied groups regarding to in hospital serious arrhythmia with pvalue=0.001 as 98% and 66.7% of subjects in the group I and group II, respectively had no arrhythmia.
• There was high statistically significant difference in between the studied groups regarding in hospital acute heart failure with pvalue= 0.0007.
• There was statistically significant difference in between the studied groups regarding in hospital reinfarction and in hospital mortality p-value 0.001, 0.026 respectively.
• Angiographic findings showed that there was a statistically significant difference in between the studied groups regarding to No reflow and Number of vessels affected.
• There was a statistically significant difference in between the studied groups regarding to ejection fraction as 51.02 and 45.67 of subjects in the group I and group II, respectively.
• There was a statistically significant difference in between the studied groups regarding to wall motion score index as 1.48 and 1.68 of subjects in the group I and group II, respectively.
• There was a statistically significant increase of BMI in group II than in group I with P= 0.03, which had mean values of 27.49and 29.52 Kg/m2 in the group I and group II, respectively.
• Also, there was a statistically significant difference in between the two groups regarding to family history with P=0.01, as 2% and 19% of subjects in the group I and group II, respectively.
• There was a statistically significant elevation of LDL in group II than in group I with P= 0.004 as 122.14 and 146.09 of subjects in the group I and group II, respectively.
• Troponin (on admission); heart rate, Persistent ST Elevation, EF (By Simpson method), Wall motion score index and elevated LPA were the most common predictors of in hospital adverse outcome.
• Lpa had a sensitivity of 90.9%, Specificity of 91.7%, Accuracy of 91.4% for prediction of major adverse cardiac event.