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Measurement of Factor V Activity in Human Plasma Using a Microplate Coagulation Assay
Published on: September 9, 2012
C-reactive protein plasma levels but not factor VII activity predict clinical outcome in patients undergoing elective
Wilhelm Grander1, Wolfgang Dichtl, Wolfgang Prokop
1Department of Internal Medicine, Division of Cardiology, University Hospital, Leopold-Franzens-University, Innsbruck, Austria. wilhelm.grander@bkh-hall.or.at
Insights
Elevated C-reactive protein (CRP) levels predict restenosis after percutaneous coronary intervention (PCI). Factor VII activity does not correlate with restenosis risk in patients with stable angina.
Area of Science:
- Cardiology
- Vascular Biology
- Biomarkers
Background:
- Vascular inflammation (C-reactive protein, CRP) and coagulation (factor VII activity, F VII) may predict restenosis after percutaneous coronary intervention (PCI).
- Stable angina pectoris patients undergoing elective PCI are the focus population.
Purpose of the Study:
- To investigate the association between baseline CRP levels, F VII activity, and restenosis rate after elective PCI.
- To evaluate these markers over a 6-month follow-up period.
Main Methods:
- Prospective study of 81 patients undergoing PCI and 49 controls.
- CRP and F VII levels measured pre-procedure and 16-24h post-procedure.
- Clinical restenosis defined as major adverse coronary events (MACE) at 6-month follow-up.
Main Results:
- Increased CRP levels post-angiography in patients with coronary artery disease.
- 17 of 81 (21%) patients experienced MACE within 6 months.
- Higher CRP tertiles independently predicted clinical restenosis (p=0.018).
- Successful PCI correlated with decreased CRP; MACE patients showed no CRP change.
- No association found between F VII activity and clinical outcome or changes over time.
Conclusions:
- Elevated preprocedural and 6-month follow-up CRP plasma levels are associated with clinical restenosis in stable angina patients undergoing PCI.
- Factor VII plasma activity does not correlate with clinical restenosis after PCI.
Background:
Both vascular inflammation as determined by C-reactive protein (CRP) and extrinsic coagulation as measured by factor VII activity (F VII) may predict clinical restenosis rate in patients with stable angina pectoris undergoing elective percutaneous coronary intervention (PCI).
Hypothesis:
The primary objective of this study was to investigate the associations between baseline CRP levels, F VII activity, and restenosis rate after elective PCI in a 6-month follow-up period.
Methods:
This prospective study included 81 patients aged > or = 19 years undergoing PCI for angiographically significant (> or = 70%) stenosis, with or without stenting, and 49 controls. Factor VII activity and CRP were measured in samples collected at angiography and 16-24 h post procedure after overnight fast. Successful PCI was defined as final diameter of < 50% with TIMI 3 flow and no complication within 1 h. After 6 months all patients who had undergone PCI were evaluated via a standardized questionnaire. Clinical restenosis was defined as the occurrence of a major adverse coronary events (MACE), within the follow-up period.
Results:
Diagnostic angiography led to a significant increase in CRP levels after 16-20 h in patients with discrete CAD (n = 22) but not in patients without any signs of coronary atherosclerosis (n = 27). During a 6-month follow-up after PCI, 17 of 81 (21%) patients developed MACE. Tertiles of CRP levels independently predicted clinical restenosis, as it developed in 33.3% of patients with the highest CRP levels (0.7-4.8 mg/dl), in 16.6% of patients with second tertile CRP levels (0.23-0.69 mg/dl), and in 7.4% of patients with lowest tertile CRP levels (0.0-0.22 mg/dl). There was a significant difference in the restenosis rate between patients from the first and the third tertiles (p = 0.018). Successful PCI was associated with a significant decrease of mean CRP levels after 6 months, whereas PCI in patients suffering from MACE led to no change in CRP levels. There was no association between factor VII activity and clinical outcome after PCI, and F VII activity did not change over a 6-month period.
Conclusions:
In patients with stable angina pectoris undergoing elective PCI, increased preprocedural and 6-month follow-up CRP plasma levels are associated with clinical restenosis. Factor VII plasma activity lacks such correlations.
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