Document Detail


Hemostatic factors and the risk of myocardial infarction or sudden death in patients with angina pectoris. European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group.
MedLine Citation:
PMID:  7845427     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Increased levels of certain hemostatic factors may play a part in the development of acute coronary syndromes and may be associated with an increased risk of coronary events in patients with angina pectoris. METHODS: We conducted a prospective multicenter study of 3043 patients with angina pectoris who underwent coronary angiography and were followed for two years. Base-line measurements included the concentrations of selected hemostatic factors indicative of a thrombophilic state or endothelial injury. The results were analyzed in relation to the subsequent incidence of myocardial infarction or sudden coronary death. RESULTS: After adjustment for the extent of coronary artery disease and other risk factors, an increased incidence of myocardial infarction or sudden death was associated with higher base-line concentrations of fibrinogen (mean +/- SD, 3.28 +/- 0.74 g per liter in patients who subsequently had coronary events, as compared with 3.00 +/- 0.71 g per liter in those who did not; P = 0.01), von Willebrand factor antigen (138 +/- 49 percent vs. 125 +/- 49 percent, P = 0.05), and tissue plasminogen activator (t-PA) antigen (11.9 +/- 4.7 ng per milliliter vs. 10.0 +/- 4.2 ng per milliliter, P = 0.02). The concentration of C-reactive protein was also directly correlated with the incidence of coronary events (P = 0.05), except when we adjusted for the fibrinogen concentration. In patients with high serum cholesterol levels, the risk of coronary events rose with increasing levels of fibrinogen and C-reactive protein, but the risk remained low even given high serum cholesterol levels in the presence of low fibrinogen concentrations. CONCLUSIONS: In patients with angina pectoris, the levels of fibrinogen, von Willebrand factor antigen, and t-PA antigen are independent predictors of subsequent acute coronary syndromes. In addition, low fibrinogen concentrations characterize patients at low risk for coronary events despite increased serum cholesterol levels. Our data are consistent with a pathogenetic role of impaired fibrinolysis, endothelial-cell injury, and inflammatory activity in the progression of coronary artery disease.
Authors:
S G Thompson; J Kienast; S D Pyke; F Haverkate; J C van de Loo
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The New England journal of medicine     Volume:  332     ISSN:  0028-4793     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  1995 Mar 
Date Detail:
Created Date:  1995-03-09     Completed Date:  1995-03-09     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  635-41     Citation Subset:  AIM; IM    
Affiliation:
Medical Statistics Unit, London School of Hygiene and Tropical Medicine.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Angina Pectoris / blood*,  complications
Blood Coagulation Factors / analysis*
C-Reactive Protein / analysis
Death, Sudden, Cardiac / etiology*
Female
Fibrinogen / analysis
Follow-Up Studies
Hemostasis
Humans
Male
Middle Aged
Myocardial Infarction / etiology*
Prospective Studies
Regression Analysis
Risk Factors
Tissue Plasminogen Activator / analysis
von Willebrand Factor / analysis
Chemical
Reg. No./Substance:
0/Blood Coagulation Factors; 0/von Willebrand Factor; 9001-32-5/Fibrinogen; 9007-41-4/C-Reactive Protein; EC 3.4.21.68/Tissue Plasminogen Activator
Comments/Corrections
Comment In:
N Engl J Med. 1995 Aug 10;333(6):389; author reply 389-90   [PMID:  7609764 ]
ACP J Club. 1995 Sep-Oct;123(2):54
N Engl J Med. 1995 Mar 9;332(10):677-8   [PMID:  7845435 ]
N Engl J Med. 1995 Aug 10;333(6):389; author reply 389-90   [PMID:  7609765 ]

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