Plasma levels of thrombin and activated protein C in patients with acute myocardial Infarction: An observational study
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Published on: March 12, 2018
Tobias Becher1,2,3, Robert Schimanski1, Jens Müller4
1First Department of Medicine (Division of Cardiology), University Medical Center Mannheim, Mannheim, Germany.
Insights
Catalytically active thrombin and activated protein C (APC) were detected in patients with acute myocardial infarction (AMI). Elevated APC levels after PCI predicted major adverse cerebrovascular events, suggesting its role in AMI complications.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Biochemistry
Background:
- The plasmatic coagulation system's activation is a key factor in acute myocardial infarction (AMI).
- Coagulation markers and thrombin activation correlate with clinical parameters and patient outcomes.
- Understanding the role of active coagulation factors in AMI is crucial for risk stratification.
Purpose of the Study:
- To measure catalytically active thrombin and activated protein C (APC) in AMI patients.
- To investigate associations between thrombin/APC levels and clinical/laboratory parameters.
- To determine if APC or thrombin levels predict adverse cerebrovascular events post-percutaneous coronary intervention (PCI).
Main Methods:
- Quantification of thrombin and APC using oligonucleotide-enzyme-capture assays (OECAs).
- Analysis in 132 AMI patients before and 24 hours after PCI.
- Correlation with markers of thrombin generation (F1+2, TAT), myocardial injury (CK, CK-MB, troponin I), and 30-day major adverse cerebrovascular events.
Main Results:
- Thrombin and APC were detectable in a subset of AMI patients before and after PCI.
- Both factors correlated with markers of thrombin generation and myocardial injury.
- Elevated APC levels post-PCI (≥0.141 ng/ml) predicted 30-day major adverse cerebrovascular events, unlike thrombin.
Conclusions:
- Enzymatically active thrombin and APC are present in the circulation of AMI patients.
- These active factors correlate with markers of myocardial injury.
- APC, but not thrombin, shows predictive value for cerebrovascular events in AMI patients post-PCI.
Introduction:
Activation of the plasmatic coagulation system is a major contributor to acute myocardial infarction (AMI). Markers of plasmatic coagulation and thrombin activation are correlated with clinical, laboratory and outcome parameters. In this study, we sought to evaluate if the catalytically active coagulation factors thrombin and activated protein C (APC) can be measured in patients with AMI and whether there are associations with laboratory or clinical parameters.
Methods:
Thrombin and APC was quantified using oligonucleotide-enzyme-capture assays (OECAs) in 132 patients presenting with AMI immediately before and 24 h after percutaneous coronary intervention (PCI).
Results:
APC was measured above the lower limit of quantification (LLOQ) in 43 (32.6%) patients before PCI (day 0) and in 55 (41.7%) patients on the following day (day 1). Thrombin was measured in 62 (47.0%) patients on day 0 and 60 (45.5%) on day 1. Both APC and thrombin were correlated with markers of thrombin generation including F1 + 2 and TAT. Additionally, APC values correlated with CK and CK-MB while thrombin correlated with CK and troponin I after PCI. APC levels above a cutoff of 0.141 ng/ml after PCI, but not thrombin, predicted 30 day major adverse cerebrovascular events.
Conclusion:
Both thrombin and APC were elevated above the LLOQ in a subset of patients with AMI before and after PCI and correlated with surrogate markers of myocardial injury. Our results indicate that enzymatically active APC and thrombin are present in the circulation of patients with AMI.
