Background: The coronary atherosclerotic burden in patients with
ST-segment elevation myocardial infarction (
STEMI) has been identified as the main predictor of prognosis. However, the association of
lipoprotein(a) [Lp(a)], a well-established proatherogenic factor, with atherosclerotic burden in patients with
STEMI is unclear. Methods: In total, 1,359 patients who underwent
percutaneous coronary intervention (PCI) for
STEMI were included in analyses. Three prespecified models with adjustment for demographic parameters and risk factors were evaluated. Generalized additive models and restricted cubic spline analyses were used to assess the relationships of Lp(a) with Gensini scores and the
no-reflow phenomenon. Kaplan-Meier curves were generated to explore the predictive value of Lp(a) for long-term all-cause mortality. Furthermore,
mRNA expression levels of LPA in different groups were compared using the GEO database. Results: Patients in the highest tertile according to Lp(a) levels had an increased incidence of
heart failure during hospitalization. Furthermore, patients with high levels of Lp(a) (>19.1 mg/dL) had sharply increased risks for a higher Gensini score (P for trend = 0.03) and no-reflow (P for trend = 0.002) after adjustment for demographic parameters and risk factors. During a median follow-up of 930 days, 132 deaths (9.95%) were registered. Patients with high levels of Lp(a) (>19.1 mg/dL) had the worst long-term prognosis (P for trend < 0.0001). In a subgroup analysis, patients with higher Lp(a) still had the highest all-cause mortality. Additionally, the
mRNA expression levels of LPA in patients with
STEMI with lower cardiac function were higher than those in other groups (P = 0.003). A higher coronary atherosclerotic burden was correlated with higher LPA expression (P = 0.01). Conclusion: This study provides the first evidence that Lp(a) (at both the
protein and
mRNA levels) is independently associated with coronary atherosclerotic lesions and prognosis in patients with
STEMI treated with PCI. Clinical Trial Registration: http://www.chictr.org.cn/index.aspx, identifier: ChiCTR1900028516.