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Elevated Baseline Serum Fibrinogen: Effect on 2-Year Major Adverse Cardiovascular Events Following Percutaneous
Lawrence Ang1, Omid Behnamfar1, Samhita Palakodeti1
1Division of Cardiovascular Medicine, San Diego Sulpizio Cardiovascular Center, University of California, La Jolla, CA.
Insights
Elevated fibrinogen levels predict major adverse cardiovascular events (MACE) up to two years after percutaneous coronary intervention (PCI). Other risk factors include acute coronary syndrome indication, longer stent length, and bare-metal or small-diameter stents.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomarkers in Cardiology
Background:
- Elevated fibrinogen is linked to short-term major adverse cardiovascular events (MACE) post-percutaneous coronary intervention (PCI).
- The association between fibrinogen levels and late MACE after PCI remains unclear.
Purpose of the Study:
- To investigate the relationship between baseline fibrinogen levels and 2-year MACE in patients undergoing non-emergent PCI.
- To identify other independent predictors of late MACE after PCI.
Main Methods:
- A cohort of 332 patients undergoing non-emergent PCI had baseline demographics and 2-year MACE outcomes recorded.
- Statistical analyses, including multivariable logistic regression, were used to assess associations between baseline characteristics and MACE.
- A landmark analysis excluded periprocedural myocardial infarction to evaluate late MACE.
Main Results:
- Higher baseline fibrinogen levels (≥280 mg/dL) were independently associated with a 3-fold increased risk of 2-year MACE (OR 3.0, CI 1.6-5.4, P<0.001).
- Other independent predictors of 2-year MACE included acute coronary syndrome indication, longer total stent length, use of bare-metal stents, and smaller stent diameter (≤2.5 mm).
- Platelet reactivity did not show a significant association with 2-year MACE.
Conclusions:
- Elevated baseline fibrinogen is a significant independent predictor of 2-year MACE after PCI.
- Factors such as acute coronary syndrome indication, stent characteristics (length, type, diameter) also independently predict late MACE.
- On-thienopyridine platelet reactivity was not associated with 2-year MACE in this cohort.
Background:
Elevated fibrinogen is associated with short-term major adverse cardiovascular events (MACE) after percutaneous coronary intervention, but the relation with late MACE is unknown.
Methods And Results:
Baseline demographics and 2-year MACE were recorded among subjects undergoing nonemergent percutaneous coronary intervention. A total of 332 subjects (66.6±19.5 years, 69.9% male, 25.3% acute coronary syndrome) were enrolled. Two-year MACE (periprocedural myocardial infarction 9.0%, rehospitalization 6.3%, revascularization 12.7%, non-periprocedural myocardial infarction 4.5%, stent thrombosis 0.9%, stroke 1.8%, and death 0.6%) were associated with higher fibrinogen (352.8±123.4 mg/dL versus 301.6±110.8 mg/dL; P<0.001), longer total stent length (40.1±25.3 mm versus 32.1±19.3 mm; P=0.004), acute coronary syndrome indication (38.7% versus 17.8%; P<0.001), number of bare-metal stents (0.5±1.1 versus 0.2±0.5; P=0.002), and stent diameter ≤2.5 mm (55.8% versus 38.4%, P=0.003). No relation between platelet reactivity and 2-year MACE was observed. Fibrinogen ≥280 mg/dL (odds ratio [OR] 3.0, confidence interval [CI], 1.6-5.4, P<0.001), total stent length ≥32 mm (OR 2.2, CI, 1.3-3.8, P<0.001), acute coronary syndrome indication (OR 4.1, CI, 2.3-7.5, P<0.001), any bare-metal stents (OR 3.2, CI, 1.6-6.1, P<0.001), and stent diameter ≤2.5 mm (OR 2.0, CI, 1.2-3.5, P=0.010) were independently associated with 2-year MACE. Following a landmark analysis excluding periprocedural myocardial infarction, fibrinogen ≥280 mg/dL remained strongly associated with 2-year MACE (37.0% versus 17.4%, log-rank P<0.001).
Conclusions:
Elevated baseline fibrinogen level is associated with 2-year MACE after percutaneous coronary intervention. Acute coronary syndrome indication for percutaneous coronary intervention, total stent length implanted, and use of bare-metal stents or smaller-diameter stents are also independently associated with 2-year MACE, while measures of on-thienopyridine platelet reactivity are not.
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