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Correlation between ST-T-segment changes with markers of hemostasis in patients with acute coronary syndromes
Raila Ehlers1, Eva Büttcher, Holger K Eltzschig
1Medizinische Klinik, Abteilung III, Eberhard-Karls-Universität, Tübingen, Germany. rehlers@rics.bwh.harvard.edu
Insights
Electrocardiogram (ECG) changes in acute coronary syndromes (ACS) correlate with elevated markers of hemostasis, including fibrinogen and thrombin-antithrombin III complex (TAT). This suggests a link between myocardial damage and a disturbed hemostatic system, potentially identifying high-risk patients.
Area of Science:
- Cardiology
- Hematology
- Biochemistry
Background:
- Acute coronary syndromes (ACS) involve complex interactions between hemostatic and inflammatory systems.
- Markers of these systems can predict future cardiac events in ACS patients.
- Electrocardiogram (ECG) is a standard tool for assessing myocardial ischemia in ACS.
Purpose of the Study:
- To investigate the correlation between serum markers of hemostasis and inflammation and ECG alterations in patients with ACS.
- To determine if specific hemostatic markers are associated with ECG findings indicative of ischemia or myocardial damage.
Main Methods:
- A standard 12-lead ECG was performed on 85 ACS patients upon admission.
- Serum markers of hemostatic and inflammatory systems were measured at admission and two days later.
- Statistical analysis compared marker levels between patients with and without specific ECG changes.
Main Results:
- Patients with ST-T changes on ECG exhibited significantly higher fibrinogen and thrombin-antithrombin III complex (TAT) levels at both time points compared to those without ECG alterations.
- Elevated tissue-type plasminogen activator (TPA) was observed in patients with initial ECG changes.
- No significant correlation was found between ECG changes and D-dimers, C-reactive protein, serum amyloid A, or soluble adhesion molecules.
Conclusions:
- A significant correlation exists between electrocardiographic changes and hemostatic system markers in ACS patients.
- The interplay between myocardial damage and a disturbed hemostatic system may help stratify patients at higher risk for recurrent coronary events.
- These findings highlight the potential of combining ECG assessment with hemostatic markers for improved risk stratification in ACS.
Background:
Disturbance of the hemostatic and the inflammatory system plays an important role in the pathophysiology of acute coronary syndromes (ACS). Their markers have been shown to predict further coronary events in patients with ACS. The prognostic value of the admission electrocardiogram (ECG), which is commonly used to evaluate ischemia, was studied previously. We investigated the correlation between serum markers of the hemostatic/inflammatory system and ECG changes in ACS.
Methods:
A standard 12-lead ECG was obtained from 85 patients with ACS on admission (0d). Markers of the hemostatic and inflammatory system were measured on admission and after 2 days (2d).
Results:
Patients with ST-T-changes had higher fibrinogen and thrombin-antithrombin III complex (TAT) levels than patients without ECG alterations at both times (fibrinogen: 0d: 492 +/- 38 vs. 357 +/- 36 mg/dl, p < 0.01; 2d: 633 +/- 55 vs. 440 +/- 50 mg/dl, p < 0.02; TAT: 0d: 7.2 +/- 1.3 vs. 3.6 +/- 0.7 microg/l, p < 0.05; 2d: 5.3 +/- 0.9 vs. 3.2 +/- 0.5 microg/l, p < 0.05). Tissue-type plasminogen activator (TPA) was elevated in patients with ECG changes initially (10.1 +/- 0.6 vs. 7.2 +/- 0.7 ng/ml, p < 0.02). D-dimers, the acute-phase proteins C-reactive protein, serum amyloid A and the soluble adhesion molecules showed no significance.
Conclusions:
The data reveal a correlation between electrocardiographic changes and hemostasis in patients with ACS. The association of myocardial damage and a disturbed hemostatic system might stratify patients who are at high risk of suffering further coronary events.