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Thrombus precursor protein and clinical outcomes in patients with acute coronary syndromes.

Abstract：

OBJECTIVES:We sought to test the prognostic performance of thrombus precursor protein (TpP) in patients presenting with an acute coronary syndrome (ACS). BACKGROUND:Because thrombus formation is a critical step in the development of ACS, a measurement of activated coagulation could yield important information. Thrombus precursor protein is a biomarker that is used to measure soluble fibrin polymers, which are the penultimate products in fibrin formation. METHODS:We measured the levels of TpP in 284 healthy volunteers and in 2,349 patients with ACS. RESULTS:Median TpP concentrations were 3.6 mug/ml (interquartile range 2.6 to 5.5) in the volunteers and 8.9 mug/ml (interquartile range 4.9 to 15.9) in the ACS patients (p < 0.001). Patients with ACS who had elevated TpP were older, more likely to be women, and more likely to have diabetes and pre-existing CAD (p < 0.02 for each). Thrombus precursor protein levels greater than the median were associated with a significantly increased risk for the composite of death, myocardial infarction (MI), or recurrent ischemia leading to rehospitalization or urgent revascularization through 10 months (hazard ratio [HR] 1.45, p < 0.001), as well as death or MI (HR 1.42, p = 0.02). We found that TpP correlated only weakly with cardiac troponin I, B-type natriuretic peptide, and high-sensitivity C-reactive protein (|r| <0.15 for each). After adjusting for clinical characteristics, cardiac troponin I, high-sensitivity C-reactive protein, and B-type natriuretic peptide, we found that patients with TpP levels greater than the median remained at significantly increased risk for the composite outcome (adjusted HR 1.51, p = 0.001) and death or MI (adjusted HR 1.58, p = 0.02). CONCLUSIONS:In patients with ACS, increased levels of TpP are associated with an increased risk of death or ischemic complications. The incorporation of a marker of activated coagulation, such as TpP, with established cardiovascular risk factors may offer valuable complementary insight into risk assessment in ACS.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Mega JL,Morrow DA,de Lemos JA,Mohanavelu S,Cannon CP,Sabatine MS

doi

10.1016/j.jacc.2008.01.069

subject

Has Abstract

pub_date

2008-06-24 00:00:00

pages

2422-9

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(08)01201-1

journal_volume

pub_type

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Thrombus precursor protein and clinical outcomes in patients with acute coronary syndromes.