Impaired endogenous fibrinolysis in ST-segment elevation myocardial infarction patients undergoing primary...

Area of Science:

• Cardiovascular Medicine
• Thrombosis and Hemostasis
• Interventional Cardiology

Background:

• The endogenous fibrinolytic system is crucial for preventing thrombotic occlusion and infarction.
• ST-segment elevation myocardial infarction (STEMI) patients often receive dual antiplatelet therapy (DAPT), but some remain at high risk.
• Identifying these high-risk patients is essential for optimizing treatment strategies.

Purpose of the Study:

• To determine if impaired endogenous fibrinolysis can identify STEMI patients at high cardiovascular risk despite DAPT.
• To assess the predictive value of fibrinolysis for major adverse cardiovascular events (MACE).

Main Methods:

• A prospective, observational study of 496 STEMI patients undergoing primary percutaneous coronary intervention (PPCI).
• Blood samples analyzed for thrombotic status using a global thrombosis test pre-PPCI, at discharge, and 30 days post-PPCI.
• Patients followed for 1 year to record MACE, including cardiovascular death and myocardial infarction.

Main Results:

• 14% of patients exhibited impaired endogenous fibrinolysis (baseline lysis time ≥2500 s).
• Impaired fibrinolysis was a strong predictor of recurrent MACE (HR 9.1), cardiovascular death (HR 18.5), and myocardial infarction (HR 6.2).
• Fibrinolysis remained predictive after adjusting for conventional risk factors, and its assessment improved MACE prediction by over 50%.

Conclusions:

• Assessment of endogenous fibrinolysis effectively identifies STEMI patients at very high cardiovascular risk, even with PPCI and DAPT.
• These findings suggest a need for further research into personalized antithrombotic or anticoagulant therapies for high-risk patients.
• Spontaneous ST-segment resolution correlated with more effective fibrinolysis, highlighting a potential early indicator of fibrinolytic capacity.