Association of Fibrinogen Level and Index of Microcirculatory Resistance In Acute ST-Segment Elevation Myocardial Infarction Patient Undergoing Primary Percutaneus Coronary Intervention
AbstractBackground: Primary percutaneus coronary intervention (PPCI) is a first of choice to return patient’s blood flow and perfusion with ST-segment elevation myocardial infarction (STEMI), however reperfusion in macrocirculation level is not always accompanied by a sufficient microcirculation reflow due to Microvascular Obstruction (MVO). Previous study demonstrated thathigh fibrinogen concentration may affect rheological parameters of the blood and play an important role in the pathomechanism of myocardial non-reperfusion phenomenon following successful mechanical recanalisation of the infarct-related coronary artery. Another study show eda more compact, lysis-resistant fibrin network in no reflow group, but without significant relation to fibrinogen level. However, there is a lack of data regarding fibrinogen and MVO. The aim of this study is to evaluate association between fibrinogen and MVO by index of microcirculatory resistance (IMR).
Methods. 55 STEMI patients undergoing primary PCI were consecutively included. The fibrinogen was evaluated using clauss method and IMR was done right after PPCI to evaluate MVO.
Results. From fifty-five patients included in the study, there were 87,3% men, with mean age 53,1±8.9 years old, and smoker show the biggest proportion compare with risk factor for coronary artery disease. All the patient undergo primary percutaneus coronary intervention with mean door-to-ballon time of 89.04+37.114 minute and ischemia time of 458,69+170,709 minute. Mean IMR was 55,2 + 47,454 and mean fibrinogen level was 350,8+103,19. From the scaterred plot fibrinogen prone to had a weak negative correlation with IMR and statistically non-significant(r = -0,137; p=0,319).
Conclusion. There is no correlation between fibrinogen level and IMR value in STEMIpatients undergoing PPCI
2. O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013;127:e362-425.
3. Bekkers SCAM, Yazdani SK, Virmani R, Waltenberger J. Microvascular Obstruction. Underlying Pathophysiology and Clinical Diagnosis. J Am Coll Cardiol 2010;55:1649-60.
4. G Gerber BL, Rochitte CE, Melin JA. et al. Microvascular obstruction and left ventricular remodeling early after acute myocardial infarction. Circulation 2000;101:2734-41.
5. Wu KC, Zerhouni EA, Judd RM. et al. Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation 1998;97:765-72.
6. Michaels AD, Gibson CM, Barron HV. Microvascular dysfunction in acute myocardial infarction: focus on the roles of platelet and inflammatory mediators in the no-reflow phenomenon. The American journal of cardiology 2000;85:50B-60B.
7. Meade TW, North WR, Chakrabarti R, et al. Haemostatic function and cardiovascular death: early results of a prospective study. Lancet 1980;1:1050-4.
8. Lowe GD, Drummond MM, Lorimer AR, et al. Relation between extent of coronary artery disease and blood viscosity. British medical journal 1980;280:673-4.
9. Wilhelmsen L, Svardsudd K, Korsan-Bengtsen K, Larsson B, Welin L, Tibblin G. Fibrinogen as a risk factor for stroke and myocardial infarction. The New England journal of medicine 1984;311:501-5.
10. Zalewski J, Undas A, Godlewski J, Stepien E, Zmudka K. No-reflow phenomenon after acute myocardial infarction is associated with reduced clot permeability and susceptibility to lysis. Arteriosclerosis, thrombosis, and vascular biology 2007;27:2258-65.
11. Ajjan R, Lim BC, Standeven KF, et al. Common variation in the C-terminal region of the fibrinogen beta-chain: effects on fibrin structure, fibrinolysis and clot rigidity. Blood 2008;111:643-50.
12. Blomback B. Fibrinogen and fibrin--proteins with complex roles in hemostasis and thrombosis. Thrombosis research 1996;83:1-75.
13. Scott EM, Ariens RA, Grant PJ. Genetic and environmental determinants of fibrin structure and function: relevance to clinical disease. Arteriosclerosis, thrombosis, and vascular biology 2004;24:1558-66.
14. Wasilewski J, Osadnik T, Polonski L. High baseline fibrinogen concentration as a risk factor of no tissue reperfusion in ST-segment elevation acute myocardial infarction treated with successful primary percutaneous coronary intervention. Kardiologia polska 2006;64:967-72; discussion 73-4.
15. McGeoch R, Watkins S, Berry C, et al. The index of microcirculatory resistance measured acutely predicts the extent and severity of myocardial infarction in patients with ST-segment elevation myocardial infarction. JACC Cardiovascular interventions 2010;3:715-22.
16. Sciagra R, Parodi G, Migliorini A, et al. ST-segment analysis to predict infarct size and functional outcome in acute myocardial infarction treated with primary coronary intervention and adjunctive abciximab therapy. The American journal of cardiology 2006;97:48-54.
17. Benderly M, Graff E, Reicher-Reiss H, Behar S, Brunner D, Goldbourt U. Fibrinogen is a predictor of mortality in coronary heart disease patients. The Bezafibrate Infarction Prevention (BIP) Study Group. Arteriosclerosis, thrombosis, and vascular biology 1996;16:351-6.
18. Mosesson MW. Fibrinogen and fibrin structure and functions. Journal of thrombosis and haemostasis : JTH 2005;3:1894-904.
19. Fatah K, Silveira A, Tornvall P, Karpe F, Blomback M, Hamsten A. Proneness to formation of tight and rigid fibrin gel structures in men with myocardial infarction at a young age. Thrombosis and haemostasis 1996;76:535-40.
20. Fatah K, Hamsten A, Blomback B, Blomback M. Fibrin gel network characteristics and coronary heart disease: relations to plasma fibrinogen concentration, acute phase protein, serum lipoproteins and coronary atherosclerosis. Thrombosis and haemostasis 1992;68:130-5.
21. Kamath S, Lip GY. Fibrinogen: biochemistry, epidemiology and determinants. QJM : monthly journal of the Association of Physicians 2003;96:711-29.
22. Standeven KF, Ariens RA, Grant PJ. The molecular physiology and pathology of fibrin structure/function. Blood reviews 2005;19:275-88.
23. Harker LA, Slichter SJ. Platelet and fibrinogen consumption in man. The New England journal of medicine 1972;287:999-1005.
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