Coagulation indicators in chronic stable effort angina and unstable angina: relationship with acute phase reactants and clinical outcome.
The aim of the study was to evaluate which pattern of coagulation indicators characterizes unstable angina and, particularly, its relationship with short-term prognosis. Forty patients with unstable angina (UA Group) at admission in the intensive care unit, 40 patients with chronic stable effort angina (SEA Group), and 20 age- and sex-matched healthy controls were studied. Blood coagulation indicators were fibrinogen, prothrombin fragment F1 + 2 (F1 + 2), thrombus precursor protein (TpP), and D-dimer. C reactive protein (CRP) and cardiac Troponin I (cTnI) have also been determined and compared. Patients in the UA Group were followed for in-hospital adverse events (sudden death, acute myocardial infarction and angina refractory to medical therapy). CRP, D-dimer and cTnI plasma levels were significantly lower in the SEA Group than in the UA Group; the same trend was found for fibrinogen and F1 + 2 plasma levels, although not statistically significant. The TpP was similar in all groups. The control group showed the lowest levels for all indicators. Within the UA Group, 17 patients developed adverse events during hospitalization; F1 + 2, D-dimer, cTnI and CRP plasma levels were higher in these patients than in those with good outcome. Relative risks for adverse events associated with the highest tertile of D-dimer, cTnI, and CRP plasma levels were 8.4 (95% confidence interval, 1.5-48.9), 6.7 (95% confidence interval, 1.1-38.6) and 5.2 (95% confidence interval, 1.1-25.2), respectively. D-Dimer is significantly increased in patients with unstable angina and, in particular, in those who develop an adverse event.
Fiotti
N
N
U.C.O. Clinica Medica Generale e Terapia Medica Dipartimento di Scienze Cliniche, Morfologiche e Tecnologiche, Università degli Studi di Trieste, Trieste, Italy. fiotti@univ.trieste.it
Di Chiara
A
A
Altamura
N
N
Miccio
M
M
Fioretti
P
P
Guarnieri
G
G
Giansante
C
C
D000209:Acute-Phase Proteins / Q000032:analysis*; D000368:Aged; D000787:Angina Pectoris / Q000097:blood* / Q000188:drug therapy / Q000209:etiology; D000789:Angina, Unstable / Q000097:blood* / Q000188:drug therapy; D015415:Biomarkers; D001798:Blood Proteins / Q000032:analysis*; D002097:C-Reactive Protein / Q000032:analysis; D002908:Chronic Disease; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D005340:Fibrinogen / Q000032:analysis; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009363:Neoplasm Proteins; D010446:Peptide Fragments / Q000032:analysis; D010544:Peroxidases / Q000032:analysis; D061105:Peroxiredoxin III; D054464:Peroxiredoxins; D005082:Physical Exertion; D011379:Prognosis; D020033:Protein Isoforms / Q000097:blood; D011516:Prothrombin / Q000032:analysis; D012307:Risk Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood*
D000209:Acute-Phase Proteins; D015415:Biomarkers; D001798:Blood Proteins; D005338:Fibrin Fibrinogen Degradation Products; D009363:Neoplasm Proteins; D010446:Peptide Fragments; D020033:Protein Isoforms; D019210:Troponin I; C036309:fibrin fragment D; C045879:prothrombin fragment 1.2; D011516:Prothrombin; D005340:Fibrinogen; D002097:C-Reactive Protein; D010544:Peroxidases; C516115:PRDX3 protein, human; D061105:Peroxiredoxin III; D054464:Peroxiredoxins