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INTRODUCTION We investigated whether apolipoprotein A1 (ApoA1) could better identify patients with severe vessel damage than HDL-cholesterol in a population with recent acute myocardial infarction (AMI). METHODS One hundred and forty-one male patients (mean age: 54.3 +/- 7.3 years) who had undergone coronary angiography within 3 weeks of an AMI were studied. Coronary angiography data were evaluated both anatomically (as single, double or multivessel disease) and by means of the Gensini score. The main lipid parameters were evaluated on admission to the Coronary Care Unit. RESULTS ApoA1 and the ApoA1/ApoB ratio (A1/B) mean values were significantly (P 18), there was a statistically significant difference for ApoA1 (P < 0.01), HDL-cholesterol and A1/B (P < 0.05): only this latter was able to discriminate between the two groups. The mean ApoA1 and A1/B (P < 0.01), Gensini score (P < 0.001) and total cholesterol/HDL-cholesterol (P < 0.05) values of patients in the single-vessel disease group differ from those both of double- and multivessel disease groups. A1/B is also able to discriminate between single- and double-vessel disease. DISCUSSION Our results confirm that ApoA1 and ApoA1/ApoB ratio are better than HDL-cholesterol in assessing the severity of coronary damage.