IS THERE ANY ASSOCIATION BETWEEN THE ADMISSION PLASMA FIBRINOGEN LEVEL AND THE TIMI FRAME COUNT MEASURED AFTER CORONAY ANGIOGRAPHY IN PATIENTS WITH ACUTE ST SEGMENT ELEVATION MYOCARDIAL INFARCTION ?

Yıl 2019, , 167 - 171, 27.08.2019

A. Savaş Çelebi , Serkan Gökaslan

https://doi.org/10.18229/kocatepetip.505239

Öz

OBJECTIVE: Increased plasma fibrinogen level is associated with adverse events in patients with acute ST-segment elevation myocardial infarction. However, the exact pathophysiologic mechanism is unknown. In this study, we evaluated the association between admission plasma fibrinogen level and reperfusion response to fibrinolytic therapy.

MATERIAL AND METHODS: The study included 128 patients (79 males, 49 females; mean age 56.3 ±7.4 years) who received fibrinolytic therapy within the first 12 hours of symptom onset for acute ST-segment elevation MI. Venous blood samples were obtained to determine admission plasma fibrinogen level and subsequently, fibrinolytic therapy administered. Coronary angiography was performed within the first 72 hours and the TIMI frame count was measured for the infarct-related artery. TIMI frame counts of <40 and ≥40 were defined as complete and incomplete reperfusion, respectively.

RESULTS: Complete reperfusion was achieved in 52 patients (40.6%) and reperfusion incomplete in 76 patients (59.4%). Patients with complete reperfusion had a significantly lower admission plasma fibrinogen level compared to those with incomplete reperfusion response (322±26.4 mg/dl vs 498±36.8 mg/dl; p=0.006). Increased admission fibrinogen level was an independent predictor of incomplete reperfusion response to fibrinolytic therapy (OR=4.8, %95 CI 1.2-17.3; p<0.0001)

CONCLUSIONS: Higher plasma fibrinogen level is associated with both insufficient reperfusion response to fibrinolytic therapy and poor prognosis.

Anahtar Kelimeler

Fibrinogen, Fibrinolytic therapy, Coronary angiography

AKUT ST-SEGMENT YÜKSELMELİ MİYOKART İNFARKTÜSLÜ HASTALARDA BAŞVURU SIRASINDAKİ PLAZMA FİBRİNOJEN DÜZEYİ FİBRİNOLİTİK TEDAVİ SONRASI ÖLÇÜLEN TIMI KARE SAYISIYLA İLİŞKİLİ MİDİR ?

Öz

AMAÇ: Artmış plazma fibrinojen düzeyi akut koroner sendromda kötü prognoz ve istenmeyen kardiyovasküler olaylarla ilişkilidir. Ancak bu durumun patofizyolojisi yeterince bilinmemektedir. Biz bu çalışmada, akut ST-segment yükselmeli miyokard infarktüsü hastalarında fibrinolitik tedaviye yanıtın fibrinojen düzeyi ile ilişkisini araştırdık.

GEREÇ VE YÖNTEM: Çalışmaya, akut ST-segment yükselmeli miyokard infarktüsü nedeniyle semptomların ilk 12 saati içinde fibrinolitik tedavi uygulanan 128 hasta (79 erkek, 49 kadın ort yaş 56.3 ±7.4) alındı. Hastalardan başvurudan hemen sonra plazma fibrinojen düzeyi ölçüldü ve intravenöz fibrinolitik tedavi uygulandı. Hastalara ilk 72 saat içinde koroner anjiyografi yapıldı ve infarktla ilişkili arter için TIMI kare sayısı hesaplandı. TIMI kare sayısının ≥40 olması yetersiz reperfüzyon, <40 olması ise tam reperfüzyon olarak tanımlandı.

BULGULAR: Hastaların 52’sinde (%40.6) tam reperfüzyon, 76’sınde (%59.4) ise yetersiz reperfüzyon saptandı. Plazma fibrinojen düzeyi tam reperfüzyon sağlanan hastalarda, sağlanmayanlara kıyasla anlamlı olarak düşüktü (322±26.4 mg/dl ve 498±36.8 mg/dl; p=0.006). Başvuru esnasında ölçülen yüksek fibrinojen düzeyi fibrinolitik tedaviye yetersiz perfüzyon yanıtının bağımsız öngördürücüsü idi (OR=4.8, %95 güven aralığı 1.2-17.3; p<0.0001).

SONUÇ: Fibrinolitik tedavi uygulanan akut ST-segment yükselmeli miyokard infaktüslü hastalarda başvuru esnasında plazma fibrinojen yüksekliği, fibrinolitik tedaviye yetersiz reperfüzyon yanıtıyla dolayısıyla kötü prognozla ilişkili olabilir.

Anahtar Kelimeler

Fibrinojen, fibrinolitik tedavi, koroner anjiyografi, miyokart enfarktüsü

Kaynakça

• 1- Kannel WB, Wolf PA, Castelli WP, D'Agostino RB. Fibrinogen and risk of cardiovascular disease. The Framingham Study. JAMA. 1987 Sep 4;258(9):1183-6.2- Rallidis LS, Zolindaki MG, Manioudaki HS, Laoutaris NP, Velissaridou AH, Papasteriadis EG. Prognostic value of C-reactive protein, fibrinogen, interleukin-6, and macrophage colony stimulating factor in severe unstable angina Clin Cardiol. 2002 Nov;25(11):505-10.3- Verheggen PW, de Maat MP, Cats VM, et al.. Inflammatory status as a main determinant of outcome in patients with unstable angina, independent of coagulation activation and endothelial cell function. Eur Heart J. 1999 Apr;20(8):567-744- Ang L, Behnamfar O, Palakodeti S, et al. Elevated Baseline Serum Fibrinogen: Effect on 2-Year Major Adverse Cardiovascular Events Following Percutaneous Coronary Intervention. J Am Heart Assoc. 2017 Nov 18;6(11).5- Takemura G, Nakagawa M, Kanamori H, Minatoguchi S, Fujiwara H. Benefits of reperfusion beyond infarct size limitation. Cardiovasc Res. 2009 Jul 15;83(2):269-76.6- van Domburg RT, Sonnenschein K, Nieuwlaat R, et al. Sustained benefit 20 years after reperfusion therapy in acute myocardial infarction. J Am Coll Cardiol. 2005 Jul 5;46(1):15-20.7- Huynh T, Perron S, O'Loughlin J, et al. Comparison of primary percutaneous coronary intervention and fibrinolytic therapy in ST-segment-elevation myocardial infarction: bayesian hierarchical meta-analyses of randomized controlled trials and observational studies. Circulation. 2009 Jun 23;119(24):3101-9.8- Wallace EL, Kotter JR, Charnigo R, et al. Fibrinolytic therapy versus primary percutaneous coronary interventions for ST-segment elevation myocardial infarction in Kentucky: time to establish systems of care? South Med J. 2013 Jul;106(7):391-89- The effects of tissue plasminogen activator, streptoki- nase, or both on coronary-artery patency, ventricular function, and survival after acute myocardial infarc- tion. The GUSTO Angiographic Investigators. N Engl J Med 1993;329:1615-22.10- Gibson CM, Cannon CP, Daley WL, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation 1996;93:879-88.11- Smith EB. Fibrinogen and atherosclerosis. Wien Klin Wochenschr. 1993;105(15):417-2412- Smith EB. Lipids and plasma fibrinogen: early and late composition of the atherosclerotic plaque. Cardiologia. 1994 Dec;39(12 Suppl 1):169-72.13- Zhou B, Pan Y, Yu Q, Zhai Z. Fibrinogen facilitates atherosclerotic formation in Sprague-Dawley rats: A rodent model of atherosclerosis. Exp Ther Med. 2013 Mar;5(3):730-73414- Zhang Y, Zhu CG, Guo YL, et al. Fibrinogen and the Severity of Coronary Atherosclerosis among Adults with and without Statin Treatment: Lipid as a mediator. Heart Lung Circ. 2016 Jun;25(6):558-6715- Cristal N, Slonim A, Bar-Ilan I, Hart A. Plasma fibrinogen levels and the clinical course of acute myocardial infarction. Angiology. 1983 Nov;34(11):693-8.16- Coppola G, Rizzo M, Abrignani MG,et al. Fibrinogen as a predictor of mortality after acute myocardial infarction: a forty-two-month follow-up study. Ital Heart J. 2005 Apr;6(4):315-22.17- De Sutter J, De Buyzere M, Gheeraert P,et al. Fibrinogen and C-reactive protein on admission as markers of final infarct size after primary angioplasty for acute myocardial infarction. Atherosclerosis. 2001 Jul;157(1):189-96