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Fibrin clot propert...
Fibrin clot properties independently predict adverse clinical outcome following acute coronary syndrome : a PLATO substudy
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- Sumaya, Wael (author)
- Univ Sheffield, Dept Infect Immun & Cardiovasc Dis, Beech Hill Rd, Sheffield S10 2RX, S Yorkshire, England.
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- Wallentin, Lars, 1943- (author)
- Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)
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- James, Stefan K., 1964- (author)
- Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)
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- Siegbahn, Agneta, 1947- (author)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Klinisk kemi
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- Gabrysch, Katja (author)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR)
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- Bertilsson, Maria (author)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR)
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- Himmelmann, Anders (author)
- AstraZeneca Res & Dev, Gothenburg, Sweden.
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- Ajjan, Ramzi A. (author)
- Univ Leeds, Leeds Inst Cardiovasc & Metab Med, Leeds, W Yorkshire, England.
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- Storey, Robert F. (author)
- Univ Sheffield, Dept Infect Immun & Cardiovasc Dis, Beech Hill Rd, Sheffield S10 2RX, S Yorkshire, England.
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Univ Sheffield, Dept Infect Immun & Cardiovasc Dis, Beech Hill Rd, Sheffield S10 2RX, S Yorkshire, England Kardiologi (creator_code:org_t)
- 2018-01-29
- 2018
- English.
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In: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 39:13, s. 1078-1085
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Abstract
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- Aims To determine whether fibrin clot properties are associated with clinical outcomes following acute coronary syndrome (ACS).Methods and results Plasma samples were collected at hospital discharge from 4354 ACS patients randomized to clopidogrel or ticagrelor in the PLATelet inhibition and patient Outcomes (PLATO) trial. A validated turbidimetric assay was employed to study plasma clot lysis time and maximum turbidity (a measure of clot density). One-year rates of cardiovascular (CV) death, spontaneous myocardial infarction (MI) and PLATO-defined major bleeding events were assessed after sample collection. Hazard ratios (HRs) were estimated using Cox proportional hazards models. After adjusting for CV risk factors, each 50% increase in lysis time was associated with CV death/spontaneous MI [HR 1.17, 95% confidence interval (CI) 1.05-1.31; P < 0.01] and CV death alone (HR 1.36, 95% CI 1.17-1.59; P < 0.001). Similarly, each 50% increase in maximum turbidity was associated with increased risk of CV death (HR 1.24, 95% CI 1.03-1.50; P = 0.024). After adjustment for other prognostic biomarkers (leukocyte count, high-sensitivity C-reactive protein, high-sensitivity troponin T, cystatin C, N-terminal pro B-type natriuretic peptide, and growth differentiation factor15), the association with CV death remained significant for lysis time (HR 1.2, 95% CI 1.01-1.42; P = 0.042) but not for maximum turbidity. These associations were consistent regardless of randomized antiplatelet treatment (all interaction P > 0.05). Neither lysis time nor maximum turbidity was associated with major bleeding events.Conclusion Fibrin clots that are resistant to lysis independently predict adverse outcome in ACS patients. Novel therapies targeting fibrin clot properties might be a new avenue for improving prognosis in patients with ACS.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- Acute coronary syndrome
- Fibrin clot
- Lysis time
- Biomarker
Publication and Content Type
- vet (subject category)
- art (subject category)
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- By the author/editor
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Sumaya, Wael
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Wallentin, Lars, ...
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James, Stefan K. ...
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Siegbahn, Agneta ...
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Gabrysch, Katja
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Bertilsson, Mari ...
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Himmelmann, Ande ...
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Ajjan, Ramzi A.
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Storey, Robert F ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
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European Heart J ...
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Uppsala University