Related Experiment Video
Updated: Mar 14, 2026
Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Residual thrombin potential predicts cardiovascular death in acute coronary syndrome patients undergoing percutaneous
Monica Attanasio1, Rossella Marcucci1, Anna Maria Gori2
1Department Experimental and Clinical Medicine, University of Florence, Italy; Careggi University Hospital, Florence, Italy.
Insights
Residual thrombin generation (TG) in acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI) and stenting is linked to higher long-term cardiovascular death risk. This finding aids risk stratification and personalized antithrombotic therapy. Keywords: thrombin generation, acute coronary syndrome, cardiovascular death, percutaneous coronary intervention.
Area of Science:
- Cardiovascular Medicine
- Hemostasis and Thrombosis
- Interventional Cardiology
Background:
- Thrombin generation (TG) is critical in coagulation, with limited data on its acute phase association with cardiovascular death in acute coronary syndrome (ACS) patients.
- The study addresses this gap in the context of modern treatments like percutaneous coronary intervention (PCI) and dual antiplatelet therapy.
Purpose of the Study:
- To investigate the association between thrombin generation (TG) and the risk of cardiovascular death in ACS patients treated with PCI and stenting.
- To evaluate the predictive value of TG parameters for long-term cardiovascular outcomes.
Main Methods:
- A cohort of 292 ACS patients undergoing PCI with stent implantation on dual antiplatelet treatment was studied.
- Venous blood samples were collected 12-24 hours post-PCI and thrombin generation was assessed using the Calibrated Automated Thrombogram (CAT).
- Outcomes were tracked for two years, with multivariate analysis adjusting for risk scores and platelet reactivity.
Main Results:
- Higher levels of endogenous thrombin potential (ETP), peak thrombin, and velocity index were observed in patients who died from cardiovascular causes compared to survivors.
- Residual TG remained a significant predictor of cardiovascular death after adjustment for the Global Registry of Acute Coronary Events (GRACE) risk score.
- The association between TG parameters and cardiovascular death persisted even after adjusting for high on-treatment platelet reactivity.
Conclusions:
- ACS patients exhibiting residual thrombin generation after PCI and stenting face a significantly elevated risk of long-term cardiovascular death.
- These findings can enhance risk stratification strategies for ACS patients.
- The results support the development of tailored antithrombotic therapies based on individual TG profiles.
Introduction:
Thrombin generation (TG) is a central step of the coagulation system involved in hemostatic and thrombotic roles. Scarce data evaluating in the acute phase the association between TG and the risk of cardiovascular death of acute coronary syndrome (ACS) patients are available, in the era of percutaneous coronary intervention (PCI) and stenting with the use of dual antiplatelet treatment.
Materials And Methods:
We investigated TG in 292 ACS patients undergoing PCI with stent implantation on dual antiplatelet treatment. Venous samples were obtained 12-24h after PCI. TG was assessed using the Calibrated Automated Thrombogram (CAT).
Results:
At two years of follow-up, 57 out of 292 patients (19.5%) died from cardiovascular causes. Higher values of endogenous thrombin potential (ETP) [1115.9 (705-1441.3) vs 940.2 (666.0-1253.1), p=0.049], peak [176.1 (80.5-259.4) vs 107.3 (59.9-181.1), p=0.002] and velocity index [61.75 (21.03-97.88) vs 25.64 (11.95-50.90), p<0.001] were observed in relation to survival patients. At the multivariate model adjusted for the Global Registry of Acute Coronary Events risk score, the association between TG and cardiovascular death remained significant for ETP [OR (95% CI): 2.58 (1.10-6.03), p=0.029], peak [OR (95%CI): 3.27 (1.35-7.92), p=0.009] and velocity index [OR (95% CI): 3.06 (1.27-7.39), p=0.013]. This result was confirmed after adjustment for high on-treatment platelet reactivity [ETP: OR (95% CI) 2.35 (1.11-5.00), p=0.027; peak: OR (95% CI) 2.42 (1.13-5.15), p=0.022; velocity index: OR (95% CI) 2.43 (1.14-5.20), p=0.022].
Conclusions:
ACS patients with a residual TG after PCI and stent implantation have a significantly higher risk of long-term cardiovascular death. These results might be useful in improving risk stratification for ACS patients and support the need of a tailored antithrombotic therapy.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...