(Circulation. 1997;96:4204-4210.)
© 1997 American Heart Association, Inc.
Articles |
Prognostic Influence of Increased Fibrinogen and C-Reactive Protein Levels in Unstable Coronary Artery Disease
From the Department of Cardiology (H.T., B.L., L.W.) and Laboratory for Coagulation Research (A.S.), Department of Clinical Laboratory Sciences, University Hospital, Uppsala, Sweden.
Correspondence to Dr Henrik Toss, Department of Cardiology, University Hospital, S-751 85 Uppsala, Sweden.
Background The prognostic influences of fibrinogen and C-reactive protein levels and their relations to myocardial damage in unstable coronary artery syndromes have not been well described.
Methods and Results Fibrinogen and C-reactive protein were
determined at inclusion and related to outcome after 5 months in 965
patients with unstable angina or non–Q-wave myocardial infarction
randomized to 5 weeks with low-molecular-weight heparin or placebo. The
probabilities of death were 1.6%, 4.6%, and 6.9%
(P=.005) and the probabilities of death and/or
myocardial infarction were 9.3%, 14.2%, and 19.1%
(P=.002), respectively, in patients stratified by
tertiles of fibrinogen (<3.38, 3.38 to 3.99, and 
4.0 g/L). The
probabilities of death were 2.2%, 3.6%, and 7.5%
(P=.003) after stratification of patient data by
tertiles of C-reactive protein level (<2, 2 to 10, and >10 mg/L). In
logistic multiple regression analysis, increased fibrinogen
levels were independently associated with the incidence of death and/or
myocardial infarction (P=.013), and elevated C-reactive
protein level was associated with the incidence of death
(P=.012). The increased relative risk of subsequent
death or myocardial infarction in individuals with an elevated
fibrinogen level was consistent in most subgroups evaluated;
although significantly so only in patients with signs of myocardial
damage.
Conclusions Increased levels of both fibrinogen and C-reactive protein are associated with a worse outcome in patients with unstable coronary artery disease. The increased risk associated with elevated fibrinogen levels is independent of, and additive to, the prognostic influence of myocardial damage.
Key Words: angina • fibrinogen • mycardial infarction • prognosis • risk factors
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