{"id":"8c1cdd31b2da","type":"article","url":"https://hartvaat.nl/2026/10/19/lipoproteine-a-geen-voorspeller-van-infarctgrootte-of-microvasculaire-schade-bij/","title":"Lipoproteïne(a) geen voorspeller van infarctgrootte of microvasculaire schade bij STEMI","title_en":"Association of lipoprotein(a) with ischemia-reperfusion injury in patients with ST-elevation myocardial infarction.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":[],"journal":"Clinical research in cardiology : official journal of the German Cardiac Society","doi":"10.1007/s00392-026-03044-9","source_url":"https://doi.org/10.1007/s00392-026-03044-9","authors":["Magdalena Holzknecht","Christina Tiller","Ivan Lechner","Fritz Oberhollenzer","Alex Kaser","Philipp Fischer","Anita Sandor","Can Gollmann-Tepeköylü","Agnes Mayr","Axel Bauer","Bernhard Metzler","Sebastian Johannes Reinstadler","Martin Reindl"],"significance":4,"published":"2026-10-27","source_date":"2026-10-19","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/"],"congress":"","summary_en":"In a prospective cohort study of 518 STEMI patients undergoing primary PCI, researchers examined the association between lipoprotein(a) [Lp(a)] and ischemia-reperfusion injury using cardiovascular magnetic resonance (CMR) and clinical outcomes. While LDL cholesterol correlated with infarct size and intramyocardial hemorrhage, Lp(a) showed no association with tissue damage or major adverse cardiovascular events. These findings suggest that Lp(a) does not influence acute ischemia-reperfusion injury or short-to-medium term prognosis in STEMI, refining the understanding of its role beyond traditional risk stratification.","created":"2026-10-20T01:16:57Z","updated":"2026-10-20T01:16:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In een prospectieve cohortstudie onder 518 STEMI-patiënten die een primaire PCI ondergingen, onderzochten onderzoekers de relatie tussen lipoproteïne(a) [Lp(a)] en ischemie-reperfusieschade via cardiovasculaire magnetresonantietomografie (CMR) en klinische uitkomsten. Hoewel LDL-cholesterol wel geassocieerd werd met infarctgrootte en intramyocardiale bloeding, toonde Lp(a) geen correlatie met weefselschade en geen verband met MACE Deze bevindingen suggereren dat Lp(a) in deze acute setting geen rol speelt bij de mate van ischemie-reperfusieschade of het prognoseverloop, wat de interpretatie van Lp(a) als risicofactor in de acute STEMI-fase nuanceert.","abstract_original":"BACKGROUND: Hypercholesterolemia adversely affects ischemia-reperfusion injury in acute ST-elevation myocardial infarction (STEMI). Lipoprotein(a) (Lp(a)) is an independent cardiovascular risk factor beyond traditional lipid markers; however, its impact on ischemic myocardial injury remains unclear. We therefore investigated the association of Lp(a) with myocardial and microvascular damage assessed by multiparametric cardiovascular magnetic resonance (CMR), as well as clinical outcomes in STEMI patients. METHODS AND RESULTS: In this prospective MARINA-STEMI (NCT04113356) cohort study, 518 STEMI patients (median age 59 years, 19% female) treated with primary percutaneous coronary intervention (PCI) were included. Lp(a) and lipid parameters, including low-density lipoprotein (LDL) cholesterol, were measured at hospital admission. CMR was performed at a median of 4 days (interquartile range (IQR) 3-5) and 4 months (IQR 4-5) after PCI. The primary objective was to assess the association of Lp(a) with infarct size (IS) and severe microvascular injury, defined as intramyocardial hemorrhage (IMH) on baseline CMR. The clinical endpoint was major adverse cardiovascular events (MACE: all-cause death, re-infarction, or new congestive heart failure). Median Lp(a) and LDL cholesterol levels were 27 nmol/l (IQR 20-90) and 141 mg/dl (IQR 117-166), respectively. LDL cholesterol correlated with IS at baseline (ρ = 0.114, p = 0.010) and was higher in patients with IMH (145 vs. 140 mg/dl, p = 0.031). In contrast, Lp(a) showed no correlation with IS (ρ = 0.051, p = 0.246) and no association with IMH (25 vs. 28 nmol/l, p = 0.632). Elevated Lp(a) (≥ 105 nmol/l) was not associated with MACE (8.7% vs. 8.8%, p = 0.966). CONCLUSIONS: While LDL cholesterol was significantly associated with IS and IMH, Lp(a) was not related to ischemia-reperfusion injury patterns or clinical outcomes in patients with STEMI treated with primary PCI."}