High baseline fibrinogen concentration as a risk factor of no tissue reperfusion in ST-segment elevation acute myocardial infarction treated with successful primary percutaneous coronary intervention.
BACKGROUND
In a large group of patients with myocardial infarction, lack of tissue reperfusion following successful recanalisation of the infarct-related epicardial artery is seen. Blood flow in the microcirculation depends not only on structural changes in the microvasculature but also on rheological features of the blood itself.


OBJECTIVE
To investigate the association between baseline fibrinogen concentration and myocardial reperfusion following successful coronary angioplasty.


METHODS
In 105 patients with acute ST-segment elevation myocardial infarction, baseline fibrinogen concentration was compared between patients with successful tissue reperfusion (n=79) and with no myocardial reperfusion (n=26) measured as the degree of ST-segment normalisation after successful recanalisation of the infarct-related artery.


RESULTS
Baseline fibrinogen concentration was significantly higher in the no-reperfusion group than in the reperfusion group (523+/-198.02 mg/dl vs 395.56+/-144.98 mg/dl, p=0.0004). In the overall study population, fibrinogen level correlated positively with maximum creatine kinase MB fraction concentration (r=0.25, p=0.012) and duration of chest pain (r=0.31, p=0.002). Mean fibrinogen concentration was higher in patients with anterior myocardial infarction than in patients with the infarct-related artery other than the left anterior descending artery. The risk of no-reflow phenomenon assessed in multivariate analysis was higher if duration of chest pain was longer (OR=1.46, CI 95% 1.06-2.16, p=0.001) and baseline fibrinogen concentration higher (OR=1.51, CI 95% 1.011-4.58, p=0.021).


CONCLUSIONS
Baseline fibrinogen concentration following successful mechanical recanalisation of the infarct-related coronary artery is an independent risk factor of a lack of myocardial reperfusion and it positively correlates with maximum creatine kinase MB fraction concentration and duration of chest pain. High fibrinogen concentration may affect rheological parameters of the blood and play an important role in the pathomechanism of myocardial no-reperfusion phenomenon following successful mechanical recanalisation of the infarct-related coronary artery.
Wasilewski
Jarosław
J
III Katedra i Oddział Kliniczny Kardiologii SlAM, ul. Szpitalna 2, 41-800 Zabrze, Poland. jaroslaw-wasilewski@wp.pl
Osadnik
Tadeusz
T
Poloński
Lech
L
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D019917:Blood Vessel Prosthesis Implantation; D004562:Electrocardiography; D005260:Female; D005340:Fibrinogen / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000628:therapy*; D015425:Myocardial Reperfusion; D015428:Myocardial Reperfusion Injury / Q000175:diagnosis* / Q000209:etiology; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
D015415:Biomarkers; D005340:Fibrinogen