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Enhanced Thrombin Generation Is Associated with Worse Left Ventricular Scarring after ST-Segment Elevation Myocardial
Ching-Hui Sia1,2, Sock-Hwee Tan2, Siew-Pang Chan3,4
1Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228, Singapore.
Insights
Enhanced thrombin generation after ST-segment elevation myocardial infarction (STEMI) correlates with increased myocardial scarring. However, it does not predict left ventricular (LV) dilatation or ejection fraction changes at six months post-MI.
Area of Science:
- Cardiology
- Biochemistry
- Medical Imaging
Background:
- Acute myocardial infarction (AMI) involves increased thrombin generation.
- Limited data exists on thrombin generation's role in left ventricular (LV) remodeling post-MI, specifically scar and dilatation.
- Left ventricular remodeling, including scarring and dilatation, significantly impacts outcomes after myocardial infarction.
Purpose of the Study:
- To investigate the association between endogenous thrombin potential (ETP) and LV remodeling, including scar size and adverse LV remodeling, in ST-segment elevation myocardial infarction (STEMI) patients.
- To compare outcomes between primary percutaneous coronary intervention (PPCI) and pharmaco-invasive management in STEMI patients.
- To assess the relationship between baseline ETP and changes in LV infarct size and LV ejection fraction (LVEF) at 6 months post-MI.
Main Methods:
- A cohort of 113 STEMI patients undergoing either PPCI or pharmaco-invasive management were studied.
- Endogenous thrombin potential (ETP) was measured at baseline, 1 month, and 6 months post-MI.
- Cardiovascular magnetic resonance imaging was used for baseline and 6-month assessments of LV infarct size and LV remodeling (LVEDV, LVEF).
Main Results:
- Each 10-unit increase in baseline ETP was significantly associated with a larger scar size (adjusted OR 1.020, p=0.027).
- Baseline ETP did not show a significant association with adverse LV remodeling or an increase in LVEF at 6 months.
- No significant differences in scar size or adverse LV remodeling were observed between PPCI and pharmaco-invasive groups, or between ticagrelor and clopidogrel users.
Conclusions:
- Enhanced thrombin generation following STEMI is linked to increased myocardial scarring at 6 months.
- Thrombin generation does not appear to be a predictor of adverse LV dilatation or improved LVEF in the early post-MI period.
- Treatment strategies (PPCI vs. pharmaco-invasive) and antiplatelet agents (ticagrelor vs. clopidogrel) did not significantly influence scar size or remodeling in this cohort.
Abstract:
Acute myocardial infarction (AMI) is associated with heightened thrombin generation. There are limited data relating to thrombin generation and left ventricular (LV) scarring and LV dilatation in post-MI LV remodeling. We studied 113 patients with ST-segment elevation myocardial infarction (STEMI) who had undergone primary percutaneous coronary intervention (PPCI) (n = 76) or pharmaco-invasive management (thrombolysis followed by early PCI, n = 37). Endogenous thrombin potential (ETP) was measured at baseline, 1 month and 6 months. Cardiovascular magnetic resonance imaging was performed at baseline and 6 months post-MI. Outcomes studied were an increase in scar change, which was defined as an increase in left ventricular infarct size of any magnitude detected by late gadolinium enhancement, adverse LV remodeling, defined as dilatation (increase) of left ventricular end-diastolic volume (LVEDV) by more than 20% and an increase in left ventricular ejection fraction (LVEF). The mean age was 55.19 ± 8.25 years and 91.2% were men. The baseline ETP was similar in the PPCI and pharmaco-invasive groups (1400.3 nM.min vs. 1334.1 nM.min, p = 0.473). Each 10-unit increase in baseline ETP was associated with a larger scar size (adjusted OR 1.020, 95% CI 1.002-1.037, p = 0.027). Baseline ETP was not associated with adverse LV remodeling or an increase in LVEF. There was no difference in scar size or adverse LV remodeling among patients undergoing PPCI vs. pharmaco-invasive management or patients receiving ticagrelor vs. clopidogrel. Enhanced thrombin generation after STEMI is associated with a subsequent increase in myocardial scarring but not LV dilatation or an increase in LVEF at 6 months post-MI.
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