(Circulation. 1999;99:2517-2522.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Thrombogenic Factors and Recurrent Coronary Events
From the Cardiology (A.J.M., W.Z., C.S.L.) and Vascular Medicine (V.J.M.) Units, Department of Medicine, the Department of Pathology (C.E.S.), the Department of Biostatistics (D.O., L.F.M.W.), and the Department of Community and Preventive Medicine (M.W.B.), University of Rochester School of Medicine and Dentistry, Rochester, NY; the Division of Hematology-Oncology (H.J.W.) and the Division of Cardiology (H.G., J.H., R.B.C.), St Luke's-Roosevelt Hospital Center, New York, NY; the Department of Medicine (R.E.G.), Uniformed Services University of the Health Sciences, Bethesda, Md; the Division of Cardiology (R.J.K.), Department of Medicine, Washington University School of Medicine, St Louis, Mo; the Department of Medicine (E.L.), Maimonides Medical Center, Brooklyn, NY; the Cardiology Section (W.C.L.), Department of Medicine, Bowman Gray School of Medicine, Winston-Salem, NC; the Cardiology Division (J.A.G.), Department of Medicine, Highland Hospital, Rochester, NY; the Cardiology Division (L.V.V.), Washington Hospital Center, Washington, DC; the Cardiology Division (M.M.B.), the Heart Institute, Long Island Jewish–Hillside Medical Center, New Hyde Park, NY; the Cardiology Unit (E.M.D.), Department of Medicine, New Jersey School of Medicine, Newark, NJ; the Cardiology Division (R.A.), Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY; and the Division of Cardiology (F.I.M.), Department of Medicine, University of Arizona Health Science Center, Tucson, Ariz.
Correspondence to Arthur J. Moss, MD, Heart Research Follow-Up Program, Box 653, University of Rochester Medical Center, Rochester, NY 14642. E-mail heartajm{at}heart.rochester.edu
Background—Thrombosis is a pivotal event in the pathogenesis of coronary disease. We hypothesized that the presence of blood factors that reflect enhanced thrombogenic activity would be associated with an increased risk of recurrent coronary events during long-term follow-up of patients who have recovered from myocardial infarction.
Methods and Results—We prospectively enrolled 1045 patients 2 months after an index myocardial infarction. Baseline thrombogenic blood tests included 6 hemostatic variables (D-dimer, fibrinogen, factor VII, factor VIIa, von Willebrand factor, and plasminogen activator inhibitor-1), 7 lipid factors [cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, lipoprotein(a), apolipoprotein (apo)A-I, and apoB], and insulin. Patients were followed up for an average of 26 months, with the primary end point being coronary death or nonfatal myocardial infarction, whichever occurred first. The hemostatic, lipid, and insulin parameters were dichotomized into their top and the lower 3 risk quartiles and evaluated for entry into a Cox survivorship model. High levels of D-dimer (hazard ratio, 2.43; 95% CI, 1.49, 3.97) and apoB (hazard ratio, 1.82; 95% CI, 1.10, 3.00) and low levels of apoA-I (hazard ratio, 1.84; 95% CI, 1.10, 3.08) were independently associated with recurrent coronary events in the Cox model after adjustment for 6 relevant clinical covariates.
Conclusions—Our findings indicate that a procoagulant state, as reflected in elevated levels of D-dimer, and disordered lipid transport, as indicated by low apoA-1 and high apoB levels, contribute independently to recurrent coronary events in postinfarction patients.
Key Words: thrombosis • coagulation • apolipoproteins • coronary disease • myocardial infarction
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