Low normal level of protein C or of antithrombin increases risk for recurrent cardiovascular events.
The relationship between haemostatic factors and recurrent cardiovascular events was investigated in patients enrolled with acute coronary syndrome (acute non-Q myocardial infarction or unstable angina pectoris). One hundred and fifteen patients, aged 64 +/- 10 years, were included in the study. Haemostatic parameters [prothrombin time, activities of factor VII, factor VIII, factor X, antithrombin (AT) and protein C (PC), and concentrations of free protein S, fibrinogen, D-dimer, prothrombin fragment 1+2, and thrombin-antithrombin complex] were measured four times: within 48 h of hospitalization, at discharge (days 5-8), at 3 months and after 1 year. Screening for factor V Leiden mutation was also performed. Patients were followed for cardiovascular endpoints (new or refractory unstable angina pectoris, non-fatal myocardial infarction, stroke, or death) for an average of 555 days. Of all patients, 35 had an endpoint during the follow-up ("endpoint" group) and 80 patients did not ("no endpoint" group). Analysing the whole follow-up period, PC (P < 0.01) and AT (P < 0.01) were lower in the "endpoint" than in the "no endpoint" group. With 50% percentiles at enrollment, the odds ratio for getting an endpoint in the low (cut-off value < 100%) versus high PC group was 2.72 (95% confidence interval, 1.18-6.29; P < 0.05). Lower levels of AT (P < 0.05) and PC (P < 0.05) during the whole follow-up were associated with a shorter event-free time. In conclusion, lower PC and AT values, even within the normal range, seem to be associated with elevated risk for recurrent cardiovascular events and shorter event-free time in acute coronary syndrome patients.
Pelkonen
K Markus
KM
Department of Medicine, Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland. markuspelkonen@suomi24.fi
Wartiovaara-Kautto
Ulla
U
Nieminen
Markku S
MS
Ahonen
Kirsi
K
Sinisalo
Juha
J
D000368:Aged; D000787:Angina Pectoris / Q000097:blood / Q000209:etiology; D000990:Antithrombin III / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D003643:Death; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006487:Hemostasis; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000209:etiology; D016017:Odds Ratio; D011486:Protein C / Q000032:analysis*; D012008:Recurrence; D012306:Risk; D020521:Stroke / Q000097:blood / Q000209:etiology
D011486:Protein C; D000990:Antithrombin III