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Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
The prognostic value of biomarkers after a premature myocardial infarction
Javier Pineda1, Francisco Marín, Pascual Marco
1Department of Cardiology, Hospital General Universitario Alicante, Alicante, Spain. pineda_jav@gva.es
Insights
High homocysteine levels, left ventricle systolic dysfunction, and smoking are key predictors of cardiovascular events in young adults who have had a heart attack. These findings highlight important risk factors for premature coronary artery disease.
Area of Science:
- Cardiovascular Medicine
- Thrombosis and Hemostasis
- Preventive Cardiology
Background:
- Intravascular thrombogenesis involves complex interactions of procoagulant state, fibrinolysis, endothelial dysfunction, and inflammation.
- Abnormalities in these systems may influence the outcome of early-onset coronary artery disease (CAD).
Purpose of the Study:
- To identify clinical and laboratory predictors of cardiovascular events in young patients (≤45 years) with acute myocardial infarction (AMI).
- To assess the association of thrombophilia, lipid profile, hypercoagulable state markers, endothelial dysfunction markers, fibrinolysis indices, and inflammation with cardiovascular outcomes over 36 months.
Main Methods:
- Prospective study of 142 young AMI patients (age ≤45 years).
- Assessment of conventional risk factors, thrombophilia markers (total homocysteine, Lp(a), APA), lipid profile, fibrinogen, D-dimer, von Willebrand factor (vWF), t-PA, PAI-1, and C-reactive protein (CRP).
- Multivariate analysis to determine independent predictors of cardiovascular events during 36-month follow-up.
Main Results:
- Elevated homocysteine levels were independently associated with cardiovascular events (OR 3.73, p=0.003).
- Left ventricle systolic dysfunction (ejection fraction <50%) was also a significant predictor (OR 3.04, p=0.050).
- Smoking habit independently predicted adverse cardiovascular outcomes (OR 2.79, p=0.032).
Conclusions:
- Cigarette smoking and left ventricle systolic dysfunction (EF<50%) are significant clinical risk factors for cardiovascular events in premature CAD.
- Higher homocysteine levels are a key prognostic marker for cardiovascular events in young AMI patients.
Background:
Intravascular thrombogenesis is influenced by a complex interplay of factors related to a procoagulant state, fibrinolysis, endothelial damage/dysfunction and inflammation. We hypothesised that abnormalities of these biological systems would contribute to outcome of coronary artery disease presenting at a young age.
Methods:
We performed a prospective study of 142 subjects presenting with acute myocardial infarction (AMI) at a young age (defined as age ≤45 years), to determine the clinical and laboratory predictors of cardiovascular events during 36 months of follow-up. We assessed conventional risk factors and abnormalities of thrombophilia [total homocysteine (tHcy), lipoprotein (a) [Lp(a)], antiphospholipid antibodies (APA)], as well as lipid profile (total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides), fibrinogen and fibrin D-dimer (as indices of a hypercoagulable state and thrombogenesis), von Willebrand factor (vWF, an index of endothelial damage/dysfunction), tissue plasminogen activator [t-PA antigen] and its inhibitor [PAI-1 antigen] (as indices of fibrinolysis), and C-reactive protein [CRP] (an index of inflammation).
Results:
In a multivariate analysis, the variables independently associated with cardiovascular events at follow-up were levels of homocysteine (OR 3.73, 95% CI (1.54-9.02); p=0.003), left ventricle systolic dysfunction (OR 3.04, 95% CI (1.00-9.25); p=0.050), and smoking habit (OR 2.79, 95% CI (1.09-7.14) p=0.032).
Conclusions:
Prognostic markers associated with cardiovascular events in premature CAD (young AMI subjects) were cigarette smoking and EF<50% of left ventricle as conventional clinical risk factors, as well as higher levels of homocysteine.
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