Objective Lipoprotein-associated phospholipase A₂ (Lp-PLA₂) is a useful inflammatory marker of cardiovascular risk, but there are only few reports of its prognostic significance as a risk factor for acute coronary syndrome (ACS). It is necessary to evaluate the association of Lp-PLA₂ with major cardiovascular events (MCVE) in patients with ACS and assess its incremental value for risk discrimination over established risk factors and biomarkers.

Methods 152 patients with ACS and one hundred forty-two patients without coronary artery disease (CAD) from Shanghai Xuhui District (aged <80 years) were enrolled from February 2007 to March 2008 and followed for a median of 6 months (4–10 months). Plasma Lp-PLA₂ activity was measured at baseline with liquid chromatography tandem mass spectrometry. Its clinical significance was evaluated with existing risk indicators.

Results Lp-PLA₂ activity was higher in patients with ACS than that in patients without CAD (22.36±1.23 mg/ml vs 19.74±3.85 mg/ml; p=0.027). During the follow-up period, 5 cases of cardiovascular death, 8 cases of non-fatal myocardial infarction, and 11 cases of target vessel revascularization occurred. Elevated Lp-PLA₂ was associated with an increased risk of MCVE (HR, 1.52; 95% CI, 1.09 to 2.37; p=0.033). The Lp-PLA₂ activity level in incidental cases was higher than that in non-incidental cases (p=0.04).

Conclusion In this community-based cohort of patients with ACS, Lp-PLA₂ was strongly and independently associated with major cardiovascular events and contributed incrementally to risk discrimination.