Abstract
ObjectiveDual antiplatelet therapy can reduce coronary thrombosis and improve the prognosis in patients with acute coronary syndrome (ACS). However, there was limited prognostic information about fibrinolytic dysregulation in patients with ACS. This study is aimed to evaluated the prevalence and impact of fibrinolytic dysregulation in patients with acute coronary syndrome (ACS).MethodsWe retrospectively analyzed coagulation and fibrinolysis related indexes of ACS in hospitalized adults with rapid thrombelastography between May 2016 and December 2018. All of the follow-up visits were ended by December 2019. The primary outcome was the occurrence of major adverse cardiovascular events (MACEs), which included unstable angina pectoris, non-fatal myocardial infarction, non-fatal cerebral infarction, heart failure and all-cause death.ResultsThree hundred thirty-eight patients were finally included with an average age of 62.5 ± 12.8 years old, 273 (80.5%) were males, 137(40.5%) patients were with ST-elevation myocardial infraction. Fibrinolysis shutdown (LY30<0.8%) and hyperfibrinolysis (LY30 >3.0%) were observed among 163 (48.2%) and 76(22.5%) patients, respectively. During a total of 603.2 person·years of follow-up period, 77 MACEs occurred (22.8%). Multivariate Cox regression analysis indicated that LY30 [HR: 1.101, 95% CI: 1.010–1.200, P = 0.028] was independently correlated with the occurrence of MACEs. The hazard ratios pertaining to MACEs in patients with fibrinolysis shutdown and hyperfibrinolysis compared with those in the physiologic range (LY30: 0.8–3.0%) were 1.196 [HR: 1.196, 95% CI: 0.679–2.109,P = 0.535] and 2.275 [HR: 2.275, 95% CI: 1.241–4.172, P = 0.003], respectively.ConclusionsFibrinolytic dysregulation is very common in selected patients with ACS, and hyperfibrinolysis (LY30 > 3%) is associated with poor outcomes in patients with ACS.
Highlights
Acute coronary syndrome (ACS), a critical disease in cardiovascular system with high morbidity and mortality, is a kind of spontaneous in situ thrombotic disease in atherosclerotic coronary arteries [1]
According to the inclusion criteria and exclusion criteria, 338 patients with acute coronary syndrome (ACS) were included in the study with an average age of 62.5 ± 12.8 years old, 272 (80.5%) were males, 137(40.5%) patients were with ST-elevation myocardial infarction (STEMI)
Univariate Cox regression analysis showed that the occurrence of Major adverse cardiovascular events (MACE) was significantly correlated with age [Hazard ratio (HR):1.043, 95%Confidence interval (CI):1.022–1.063,P
Summary
Acute coronary syndrome (ACS), a critical disease in cardiovascular system with high morbidity and mortality, is a kind of spontaneous in situ thrombotic disease in atherosclerotic coronary arteries [1]. Thromboelastography (TEG) is a commonly utilized test to evaluate the severely injured trauma patients [3, 4], which can continuously monitor the whole process of clotting, including the activation of platelet, coagulation. Admission rapid TEG data can predict in-hospital thromboembolic events [5] and guide volume resuscitation [6], and provide more useful and cost-effective evaluation of the coagulation system than multiple conventional coagulation tests [3, 7]. Either TEG detected hyperfibrinolysis or fibrinolysis shutdown was related to poor prognosis in patients with trauma or severe diseases [8–10]. In patients with CHDs, modified TEG was applied to measure platelet reactivity [11, 12] and coagulation function [13]. Little is known about abnormal fibrinolysis in patients with CHDs. In this study, we observed the prevalence profiles of abnormal fibrinolysis and tested the hypothesis that fibrinolytic dysregulation could predict clinical outcomes among patients with ACS
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