The Impact of Platelet-Fibrin Clot Strength and Endogenous Fibrinolytic Activity on Adverse Cardiac Events After Percutaneous Coronary Intervention in Patients with Coronary Artery Disease

초록

Background:The level of platelet reactivity is associated with major adverse cardiovascular events (MACE) in CAD patients undergoing PCI. However, the impact of clot strength and endogenous fibrinolytic activity on MACE post-PCI remains uncertain.Methods:We evaluated 1,814 patients who underwent PCI and measured coagulation profiles using thromboelastography (TEG®) during PCI. TEG® system indicates “Platelet-Fibrin Clot Strength” (MAthrombin: maximal amplitude of the clot dynamics) and endogenous fibrinolytic activity (LY30: percentage of the clot lysis at 30 min) together. MACE was defined as a composite of cardiac death and nonfatal myocardial infarction.Results:During the follow-up (median, 23 months), the occurrence of MACE significantly differ among patients with and without high “Platelet-Fibrin Clot Strength” (MAthrombin ≥ 68 mm) (8.8% vs. 3.8% at 3 years; HR, 2.05; 95% CI, 1.35 to 3.12; p = 0.001). Likely, patients with low fibrinolytic activity (LY30 < 1.0%) were at a greater risk for MACE, as compared with those with high fibrinolytic activity (8.1% vs. 4.4% at 3 years; HR, 1.92; 95% CI, 1.27 to 2.91; p = 0.002). These influences were maintained even after adjustment with known clinical and procedural variables. In addition, the combination of MAthrombin (≥ 68 mm) and LY30 (< 1.0%) significantly increased the predictive value for MACE occurrence by about 4-fold.Conclusion:This study is the first to show the clinical impact of clot strength and endogenous fibrinolytic activity on MACE after PCI in CAD patients, which may indicate that coagulation profiles can be important risk factors for atherothrombotic events in these patients.