Lp(a) measurement in younger patients following ST-elevation myocardial infarction: insights from a contemporary regional registry
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".