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Activated and total coagulation factor VII, and fibrinogen in coronary artery disease
R Danielsen1, P T Onundarson, H Thors
1Department of Medicine, Landspítalinn, University Hospital, Reykjavik, Iceland.
Insights
In patients with suspected coronary artery disease, activated factor VII (FVIIa) was lower and fibrinogen (FBG) was higher following a previous myocardial infarction. These coagulation factors did not correlate with coronary artery disease severity.
Area of Science:
- Cardiology
- Hematology
- Biochemistry
Background:
- Elevated fibrinogen (FBG) and coagulation factor VII (FVIIc) are linked to coronary artery disease (CAD) risk.
- The role of activated factor VII (FVIIa) in cardiovascular events requires further investigation.
Purpose of the Study:
- To assess the relationship between FVIIa, FVIIc, FBG, and clinical outcomes in patients undergoing coronary angiography.
- To investigate correlations between these markers and CAD severity, left ventricular ejection fraction, and prior clinical events.
Main Methods:
- Coronary angiography data from 401 patients with suspected CAD.
- Assessment of FVIIc, FVIIa, FBG, and conventional risk factors.
- Correlation and multivariate regression analyses to determine relationships with clinical parameters and CAD severity.
Main Results:
- FVIIa correlated positively with FVIIc but not with FBG.
- Neither FVIIa, FVIIc, nor FBG correlated with coronary artery disease severity scores.
- FVIIa was lower, and FBG was higher in patients with a prior myocardial infarction.
- FVIIc levels were associated with sex, triglycerides, and HDL cholesterol.
- FVIIa levels were associated with sex, prior percutaneous transluminal coronary angioplasty, total cholesterol, CAD duration, and smoking.
- FBG levels were associated with prior myocardial infarction, hypertension, smoking, and thrombocyte count.
Conclusions:
- In patients with suspected CAD, a prior myocardial infarction is associated with decreased FVIIa and increased FBG.
- FVIIa, FVIIc, and FBG levels are not directly related to the severity of coronary artery disease.
- These coagulation markers showed similar levels in patients with stable versus unstable angina pectoris.
Abstract:
Fibrinogen (FBG) and total coagulation factor VII (FVIIc) concentrations are higher in those patients with coronary artery disease who are at increased future risk of acute ischemic events. The relationship between activated factor VII (FVIIa) and cardiovascular events, however, has not been intensively studied. Data were collected from 401 consecutive patients who underwent coronary angiography because of suspected coronary artery disease. Conventional risk factors FVIIc, FVIIa and FBG were assessed in relation to the severity of coronary artery disease, left ventricular ejection fraction, and previous clinical events. A strong positive correlation was found between FVIIa and FVIIc (p < 0.001), but neither FVIIa nor FVIIc correlated with FBG. No correlation was found between FVIIa, FVIIc or FBG levels and stenosis score for the severity of coronary artery disease, and all were similar in patients with stable or unstable angina pectoris. Multivariate regression analysis showed FVIIc to be higher in women (p = 0.004), and positively related to triglycerides (p = 0.001) and HDL cholesterol (p = 0.006), but not to a previous myocardial infarction or total cholesterol. FVIIa, on the other hand, was lower in patients with a previous myocardial infarction (p = 0.004), higher in women (p = 0.001) and those that previously had undergone percutaneous transluminal coronary angioplasty (p = 0.039), and positively related to total cholesterol (p = 0.011), duration of coronary artery disease (p = 0.032), and smoking (p = 0.008). FBG was positively associated with a previous myocardial infarction (p = 0.013), hypertension (p = 0.016), smoking (p = 0.005), and the thrombocyte count (p < 0.001). Finally, stepwise logistic regression analysis verified a previous myocardial infarction to be negatively associated with FVIIa (p = 0.03), and positively with FBG (p = 0.03), total cholesterol (p = 0.02), and the severity of coronary artery disease (p < 0.001). In conclusion, in patients suspected of coronary artery disease undergoing cardiac catheterization, FVIIa was decreased and FBG increased in those who had a previous myocardial infarction. FVIIa, FVIIc, or FBG levels were not, however, related to the severity of coronary artery disease, and they were similar in patients with stable or unstable angina pectoris.