[Biohemorheologic factors and cardiovascular events curve in survivors of transmural acute myocardial infarct--24-month follow-up].
BACKGROUND
Previous reports have shown several biohemorheological disturbances in acute myocardial infarction (AMI), either in the acute phase and after hospital discharge. There is no clearly established relationship between these parameters and the patients' clinical outcome.


OBJECTIVE
To evaluate in transmural AMI survivors, a relationship between biohemorheological parameters and the cardiovascular events curve during a 24 month follow-up period.


METHODS
Sixty-four consecutive patients (58.0 +/- 12.0, 59 men), transmural AMI survivors (30 anterior and 34 inferior) were included in the study. Clinical follow-up was 24 months (at 6, 12 and 24 months). The following cardiovascular events (CVE) were collected: cardiovascular death, stroke, AMI, unstable angina, embolism. We determined, at hospital discharge, these biohemorheological parameters: plasma viscosity, fibrinogen, PAI-1 inhibitor, leukocyte count, C protein (C Pt), erythrocyte aggregation (EA). For each parameter we determined the 25, 50 and 75 percentiles and other significant cut-off point, grouping patients according to these values.


METHODS
Group t test, Kaplan-Meier survival curve (with the log rank test), and Cox logistic regression.


RESULTS
(1) Patients with CVE (n = 19) during the 24 months of clinical follow-up had at hospital discharge higher leukocyte count (p < 0.001), lower C Pt (p < 0.01) and lower EA (p < 0.05). (2) The higher the percentile of the leukocyte count higher the probability for a CVE. Patients with leukocyte count above the 50 percentile had 6 times more CVE (p < 0.01); (3) The higher the C Pt lower the risk for a CVE. Patients with C PT lower than the 50 percentile had 9 times more risk for a CVE (p < 0.01), and those above the 75 percentile had no CVE (p < 0.01). (4) For the EA we identified a cutoff point (= 14.5), independent of the percentiles values. Patients with EA below 14.5 had six times more CVE. By multivariate analyses, we identified leukocyte count and C Pt as independent risk predictive factors (p < 0.05).


CONCLUSIONS
In this group of transmural MI survivors a relationship was established between some biohemorheological (leukocyte count, C Pt, EA) and the CVE curve during 24 months of clinical follow-up.
Sargento
Luís
L
Instituto de Bioquímica Fisiológica, Faculdade de Medicina de Lisboa, UTIC-AC, Hospital de Santa Maria, Lisboa.
do Rosário
Henrique Sobral
HS
Perdigão
Carlos
C
Monteiro
José
J
Saldanha
Carlota
C
e Silva
J Martins
JM
D001809:Blood Viscosity; D002352:Carrier Proteins / Q000097:blood; D004903:Erythrocyte Aggregation; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D005500:Follow-Up Studies; D018056:Hemorheology; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality / Q000503:physiopathology; D011446:Prospective Studies; D017741:Survivors
D002352:Carrier Proteins; C020723:citrate-binding transport protein; D005340:Fibrinogen