Lipoprotein(a) as an Independent Predictor of Elevated SYNTAX Score

<b>Background/Objectives:</b> Increased lipoprotein(a) [Lp(a)] level is associated with elevated possibility of atherosclerosis progression. SYNTAX score enables to grade the anatomy of coronary arteries. To identify the impact of increased Lp(a) level on SYNTAX score in individuals with acute myocardial infarction (AMI). <b>Methods:</b> In our analysis, we enrolled 173 consecutive adult patients hospitalized for AMI in a tertiary cardiology center from December 2022 to August 2023. Patient characteristics were compared for patients with SYNTAX score ≥ 23 (64 patients) and SYNTAX score < 23 (109 patients). The SYNTAX score was estimated based on the results of coronary angiography. Logistic regression analyses were performed to evaluate the factors associated with SYNTAX score. <b>Results:</b> Individuals with the SYNTAX score ≥ 23 were more likely to have arterial hypertension, diabetes mellitus, significant stenosis in the left main coronary artery, and higher Lp(a) levels than those with SYNTAX < 23 (all <i>p</i> < 0.05). On univariate analysis, age (OR 1.05, 95% CI 1.02-1.08, <i>p</i> = 0.001), Lp(a) levels (OR 1.04, 95% CI 1.01-1.06, <i>p</i> = 0.001), and arterial hypertension (OR 2.69, 95% CI 1.26-5.74, <i>p</i> = 0.011) were associated with SYNTAX score ≥ 23. Multivariable determinants of SYNTAX score ≥ 23 were as follows: Lp(a) levels (OR 1.03, 95% CI 1.01-1.08, <i>p</i> = 0.029), and age (OR 1.04, 95% CI 1.01-1.07, <i>p</i> = 0.005). The cut-off value for Lp(a) 166.16 nmol/L identifies patients with SYNTAX score ≥ 23 with 97% sensitivity and 44% specificity (area under curve 0.78, <i>p</i> < 0.001). <b>Conclusions:</b> Elevated Lp(a) concentration is associated with a higher SYNTAX score. A cut-off value of Lp(a) above 166.16 nmol/L allows us to identify subjects with SYNTAX score ≥ 23 with good specificity and sensitivity.