Abstract
Objectives and BackgroundTissue factor (TF) contributes to thrombosis following plaque disruption in acute coronary syndromes (ACS). Aim of the study was to investigate the impact of plasma TF activity on prognosis in patients with ACS.Methods and ResultsOne-hundred seventy-four patients with unstable Angina pectoris (uAP) and 112 patients with acute myocardial infarction (AMI) were included with a mean follow up time of 3.26 years. On admission, plasma TF activity was assessed. Patients were categorized into 2 groups: a high-TF activity group with TF >24 pmol/L and low TF activity group with TF ≤ 24 pmol/L. Fifteen cardiovascular deaths occurred in the uAP group and 16 in the AMI group. In AMI TF activity was 24,9 ± 2,78 pmol/l (mean ± SEM) in survivors and 40,9 ± 7,96 pmol/l in nonsurvivors (P = 0.024). In uAP no differences were observed (25.0 ± 8.04 pmol/L nonsurvivors vs. 25.7 ± 2.14 pmol/L survivors; P = 0.586). Kaplan-Meier estimates of survival at 3.26 years regarding TF activity in AMI were 81.3% and 92.2% with an hazard ratio of 3.02 (95% CI [1.05–8.79], P = 0.03). The Cox proportional hazards model adjusting for correlates of age and risk factors showed that plasma TF activity was an independent correlate of survival (hazard ratio 9.27, 95% CI [1.24–69.12], P = 0.03). In an additional group of patients with uAP and AMI, we identified circulating microparticles as the prevailing reservoir of plasma TF activity in acute coronary syndromes.ConclusionSystemic TF activity in AMI has an unfavorable prognostic value and as a marker for dysregulated coagulation may add to predict the atherothrombotic risk.
Highlights
Atherothrombosis, characterized by a disruption of atherosclerotic lesions superimposed with thrombus formation, is the major cause of acute coronary syndromes (ACS) and cardiovascular death
Baseline characteristics Of the 286 patients enrolled in the study, 112 presented with acute myocardial infarction (AMI) and 174 were classified as unstable Angina pectoris (uAP)
During the follow up 16 cardiovascular deaths and 8 non-cardiovascular deaths were reported among patients with AMI; 15 cardiovascular deaths and 9 non-cardiovascular deaths were reported among patients with uAP
Summary
Atherothrombosis, characterized by a disruption of atherosclerotic lesions superimposed with thrombus formation, is the major cause of acute coronary syndromes (ACS) and cardiovascular death. Current studies have shown that plasma TF is comprised of: a) TF associated with microparticles (MP) and b) an alternatively spliced TF variant that lacks the transmembrane domain [6]. It has long been speculated that, in cases with no plaque rupture or only fractional superficial erosion, thrombus formation may depend on circulating levels of TF. Consistent with this idea, several studies suggest that the levels of circulating TF and other haemostatic biomarkers may correlate to adverse cardiovascular events and mortality in patients with ACS [13,14,15,16,17]. Aim of the present study was to investigate plasma TF activity in patients with ACS and evaluate its capacity to predict future cardiovascular and overall mortality
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