Influence of Hypercoagulability and Impaired Fibrinolysis on Occurrence of Acute Myocardial Infarction and Prognostic Implication Following Percutaneous Coronary Intervention

Introduction: Although a plaque damage such as rupture is quite commonly observed, catastrophic event with clinical symptoms is not common in real practice. Hypothesis: Hypercoagulability and impaired fibrinolysis can be associated with the risk of coronary thrombosis and long-term clinical prognosis in patients with coronary artery disease (CAD). Methods: CAD patients who underwent percutaneous coronary intervention (PCI) (n=2,705) were enrolled (presented with acute myocardial infarction [AMI], 47.8%). Global hemostatic properties were evaluated with thromboelastographic assay (TEG®) showing hypercoagulability (maximal amplitude [MA]: platelet-fibrin clot strength) and impaired fibrinolysis (LY30: percent lysis 30 minutes after maximal clot strength). Major adverse cardiovascular events (MACEs) were defined as a composite of cardiovascular death, myocardial infarction, or stroke. Results: Patients presented with AMI showed higher MA (66.5±7.8 vs. 65.3±7.2 mm, P<0.001) and lower LY30 levels (1.0±2.5% vs. 1.2±2.2%, P=0.009) compared with non-AMI patients. Combined criteria of ‘MA≥68 mm’ and ‘LY30<0.2%’ increased the risk of AMI occurrence by 1.7-fold. During 4-year follow-up, MACE was associated with ‘MA≥68 mm’ (hazard ratio [HR] 1.447, 95% confidential interval [CI] 1.051-1.992, P=0.024) and ‘LY30<0.2%’ (HR 1.328, 95% CI 0.965-1.828, P=0.081), respectively. In multivariate analysis, patients with ‘MA≥68 mm’ and ‘LY30<0.2%’ showed an increased risk of MACE compared to those with ‘MA<68 mm’ and ‘LY30≥0.2%’ (adjusted HR 1.863, 95% CI 1.191-2.913, P=0.006) (Figure 1). Subgroup analysis showed that this trend was consistent irrespective of baseline demographics and lesional characteristics. Conclusions: Hypercoagulability and impaired fibrinolysis were more frequently observed in AMI patients. In addition, these properties were significantly associated with post-PCI clinical prognosis.