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Markers of Thrombin Generation Are Associated With Long-Term Clinical Outcome in Patients With ST-Segment Elevation

Charlotte Holst Hansen1,2, Vibeke Ritschel1,2,3, Geir Øystein Andersen1,2

  • 11 Center for Clinical Heart Research, Oslo University Hospital, Ullevål, Oslo, Norway.

Clinical and Applied Thrombosis/Hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
|April 27, 2018
PubMed

Insights

Hypercoagulability markers like d-dimer and prothrombin fragment 1+2 (F1+2) in ST-segment elevation myocardial infarction (STEMI) predict long-term outcomes. Higher levels indicate increased risk, while lower endogenous thrombin potential (ETP) is also associated with adverse events.

Area of Science:

  • Cardiology
  • Thrombosis
  • Clinical Outcomes

Background:

  • The relationship between hypercoagulability and long-term outcomes in ST-segment elevation myocardial infarction (STEMI) requires clarification.
  • Assessing acute-phase markers of coagulation may provide prognostic information for STEMI patients.

Purpose of the Study:

  • To investigate the association between acute-phase prothrombin fragment 1+2 (F1+2), d-dimer, and endogenous thrombin potential (ETP) and long-term clinical outcomes in STEMI patients.

Main Methods:

  • Blood samples were collected from 987 STEMI patients median 24 hours post-symptom onset.
  • Follow-up was conducted for a median of 4.6 years, assessing a composite of major adverse cardiovascular events and total mortality.
  • Levels of F1+2, d-dimer, and ETP were measured and correlated with clinical outcomes.

Main Results:

  • Higher levels of d-dimer and F1+2 were significantly associated with increased risk for both the combined endpoint and total mortality (P < .005).
  • Lower levels of ETP were significantly associated with adverse outcomes (P < .01).
  • After covariate adjustment, d-dimer remained associated with reduced total mortality risk (P = .034), with an AUC of 0.700.

Conclusions:

  • The hypercoagulable state in acute STEMI is important for predicting long-term clinical outcomes.
  • D-dimer and F1+2 are valuable prognostic markers in STEMI.
  • ETP may also play a role in risk stratification for STEMI patients.

Keywords:
ETPclinical outcomed-dimermortalitymyocardial infarctionprothrombin fragment 1+2

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