The impact of serial measurement of plasma fibrinogen and cardiovascular outcomes after percutaneous coronary intervention in patients with coronary artery disease

초록

Background: Plasma fibrinogen level could be used to predict the risk of adverse cardiovascular events in patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI). Less is known, however, about the association between serial assessments of fibrinogen and long-term outcome after PCI.Methods: Plasma fibrinogen levels were measured in 2,316 patients undergoing PCI at baseline and one-month after PCI. We stratified patients into 4 groups according to fibrinogen levels (cutoffs of 317 mg/dL): (1) persistent low fibrinogen (n=696, 30.1%), (2) high initial fibrinogen/low one-month fibrinogen (n=343, 14.8%) group, (3) low initial fibrinogen/high one-month fibrinogen (n=504, 21.8%) group, and (4) persistent high fibrinogen (n=773, 33.4%) group. MACE was defined as a composite of cardiovascular death and non-fatal myocardial infarction.Results: With a median follow-up of 25.3 (interquartile range: 14.4–42.7) months, there were 40 cardiac deaths, 66 non-fatal myocardial infarctions. Compared with baseline fibrinogen value, follow-up measures were increased one-month after PCI (329.7±93.0 vs. 341.6±99.3, p<0.001). The rates of MACE significantly differed among the groups (log-rank test, p<0.0001, figure). After adjustment with clinical and procedural variables, persistent high fibrinogen group only remained significantly associated with a higher rate of MACE (HR, 2.00; 95% CI, 1.15 to 3.48; p=0.014).Conclusion: This is the first study to show that persistence of an increased level of plasma fibrinogen at baseline and one-month after PCI is a significant independent predictor of long-term outcome in CAD patients. Serial assessment of plasma fibrinogen revealed a substantial proportion of patients undergoing PCI persistently elevated values and were at high risk of recurrent ischemic events. Fibrinogen guided approach could select the high-risk patients favoring use of anticoagulant therapy following PCI.