Lp(a) measurement in younger patients following ST-elevation myocardial infarction: insights from a contemporary regional registry
Notice bibliographique
Résumé
Abstract Background Current guidelines recommend baseline Lipoprotein(a) (Lp(a)) measurement as part of risk stratification for future cardiovascular disease. However, the real-world implementation of these recommendations for the secondary prevention of atherosclerotic cardiovascular disease remains unclear. Purpose This study is the first to assess the practical use of Lp(a) measurement in the care of young ST-elevation myocardial infarction (STEMI) patients within a Canadian healthcare system. Methods We conducted a retrospective analysis of STEMI patients < 65 years old presenting to 13 regional hospitals between January 2016 and December 2022. The primary objective was to determine the proportion of patients who had baseline Lp(a) levels measured prior or within 1 year following their index STEMI hospitalization. The secondary objective was to identify predictors of Lp(a) measurement at any point in their lifetime in this population. Results Among 1,262 patients meeting the inclusion criteria, 1,106 (mean age 55.9±7 years, 88.1% male) were included in the final analysis. Two hundred and forty (21.7%) had an Lp(a) measurement prior or within 1 year of STEMI. Of these, 78(32.5%) had Lp(a) levels ≥100 nmol/L, while 162(67.5%) had levels <100 nmol/L. Based on univariable analysis, patients were less likely to have Lp(a) measured at any point in their lifetime if they were older (OR 0.71(95% CI:0.65, 0.78), p<0.001), had peripheral artery disease (OR 0.25(0.06, 1.09), p=0.064), had traditional coronary artery disease (CAD) risk factors (hypertension: OR 0.66(0.51,0.85), p=0.001; smoking: OR 0.64(0.48,0.85), p=0.003; stroke/TIA: OR 0.46(0.22,0.96), p=0.04) or a lower baseline LDL-C levels (OR 0.87(0.77, 0.98), p=0.027). Older age (OR 0.68(0.60, 0.75), p<0.001), smoking (0R 0.68(0.49,0.96), p=0.027), and higher BMI (OR 0.81(0.68,0.95), p=0.011) remained significantly associated with a lack of Lp(a) measurement after multivariate analysis. Among those with Lp(a) testing, approximately two-thirds had it measured before or within six months of hospitalization, while one-third had their first measurement more than 12 months post-discharge. Conclusions In the contemporary era, only 1 in 5 younger STEMI patients had LP(a) measurement within 1 year of their index event. Moreover, many patients had no Lp(a) measurement during their lifetime; this was associated with certain clinical factors such as increasing age and the presence of CAD risk factors. With the development of novel targeted therapeutics, additional studies to understand why Lp(a) is not being measured, and strategies to increase timely Lp(a) assessment in this high-risk population are warranted.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».