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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p>In this prospective MARINA-STEMI (NCT04113356) cohort study, 518 STEMI patients (median age 59\u00a0years, 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\u00a0days (interquartile range (IQR) 3\u20135) and 4\u00a0months (IQR 4\u20135) 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).<\/jats:p>\n                    <jats:p>\n                      Median Lp(a) and LDL cholesterol levels were 27\u00a0nmol\/l (IQR 20\u201390) and 141\u00a0mg\/dl (IQR\u00a0117\u2013166), respectively. LDL cholesterol correlated with IS at baseline (\n                      <jats:italic>\u03c1\u2009=<\/jats:italic>\n                      \u20090.114,\n                      <jats:italic>p\u2009=\u2009<\/jats:italic>\n                      0.010) and was higher in patients with IMH (145 vs. 140\u00a0mg\/dl,\n                      <jats:italic>p\u2009=\u2009<\/jats:italic>\n                      0.031). In contrast, Lp(a) showed no correlation with IS (\n                      <jats:italic>\u03c1\u2009=<\/jats:italic>\n                      \u20090.051,\n                      <jats:italic>p\u2009=\u2009<\/jats:italic>\n                      0.246) and no association with IMH (25 vs. 28\u00a0nmol\/l,\n                      <jats:italic>p\u2009=\u2009<\/jats:italic>\n                      0.632). Elevated Lp(a) (\u2265\u2009105\u00a0nmol\/l) was not associated with MACE (8.7% vs. 8.8%,\n                      <jats:italic>p\u2009=\u2009<\/jats:italic>\n                      0.966).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>While LDL cholesterol was significantly associated with IS and IMH, Lp(a) was not related to ischemia\u2013reperfusion injury patterns or clinical outcomes in patients with STEMI treated with primary PCI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical abstract<\/jats:title>\n                    <jats:p>\n                      \"Image missing\"\n                      \n                    <\/jats:p>\n                    <jats:p>\n                      Created in\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/BioRender.com\" ext-link-type=\"uri\">https:\/\/BioRender.com<\/jats:ext-link>\n                    <\/jats:p>\n                    <jats:p>MACE: composite of all-cause death, myocardial re-infarction and new congestive heart failure after discharge for the index event.<\/jats:p>\n                    <jats:p>Lp(a) concentrations\u2009\u2265\u2009105\u00a0nmol\/l are considered elevated according to current guidelines [1].<\/jats:p>\n                    <jats:p>CMR\u2009=\u2009cardiovascular magnetic resonance; IMH\u2009=\u2009intramyocardial hemorrhage; IS\u2009=\u2009infarct size; LDL\u2009=\u2009low-density lipoprotein cholesterol; Lp(a)\u2009=\u2009lipoprotein(a); LVMM\u2009=\u2009left ventricular myocardial mass; MACE\u2009=\u2009major adverse cardiovascular events; pPCI\u2009=\u2009primary percutaneous coronary intervention; STEMI\u2009=\u2009ST-elevation myocardial infarction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00392-026-03044-9","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T08:51:43Z","timestamp":1792399903000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of lipoprotein(a) with ischemia\u2013reperfusion injury in patients with ST-elevation myocardial infarction"],"prefix":"10.1007","author":[{"given":"Magdalena","family":"Holzknecht","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Tiller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Lechner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fritz","family":"Oberhollenzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Kaser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Fischer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Sandor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Can","family":"Gollmann-Tepek\u00f6yl\u00fc","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnes","family":"Mayr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Bauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Metzler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian Johannes","family":"Reinstadler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8414-9552","authenticated-orcid":false,"given":"Martin","family":"Reindl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"issue":"42","key":"3044_CR1","doi-asserted-by":"publisher","first-page":"4359","DOI":"10.1093\/eurheartj\/ehaf190","volume":"46","author":"F Mach","year":"2025","unstructured":"Mach F, Koskinas KC, Roeters van Lennep JE, Tokgozoglu L, Badimon L, Baigent C et al (2025) 2025 Focused Update of the 2019 ESC\/EAS Guidelines for the management of dyslipidaemias. 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