Reduced clot permeability and susceptibility to lysis in patients with acute coronary syndrome: effects of inflammation and oxidative stress.
BACKGROUND
Stable angina is associated with unfavorable fibrin structure/function. It is not known how acute coronary syndromes (ACS) affect fibrin architecture.


OBJECTIVE
We investigated fibrin clot properties and their determinants in ACS patients.


METHODS
Clot permeability, turbidity and fibrinolysis were assessed in 40 patients with ACS versus 40 controls with stable angina matched for age, sex, and risk factors.


RESULTS
Patients with ACS had lower clot permeability (p=0.001), faster fibrin polymerization (p=0.008), and prolonged fibrinolysis time (p<0.0001) than controls. C-reactive protein (CRP) and 8-epi-prostaglandin F(2alpha), a marker of oxidative stress, were the only independent predictors of clot permeability (R(2)=-0.74; p<0.0001 and R(2)=-0.65; p<0.0001, respectively) and fibrinolysis time in ACS patients (R(2)=0.60; p<0.0001 and R(2)=0.59; p=0.0002, respectively). In angina patients, fibrinogen and CRP predicted permeability (R(2)=-0.71; p<0.0001 and R(2)=-0.62; p<0.0001), and D-dimer predicted lysis time (R(2)=0.54; p=0.0005). In regression analysis models incorporating all patients, the only independent predictor of all clot variables was being an ACS patient (R(2) 0.51 to 0.85; p<0.001).


CONCLUSIONS
This first study of clot properties in patients during an ACS demonstrated that compared with stable angina patients, their clots are composed of dense networks that are more resistant to lysis and these features are correlated with raised CRP and oxidative stress.
Undas
Anetta
A
Institute of Cardiology, Jagiellonian University School of Medicine, 80 Pradnicka Str. 31-202 Cracow, Poland. mmundas@cyf-kr.edu.pl
Szułdrzynski
Konstanty
K
Stepien
Ewa
E
Zalewski
Jarosław
J
Godlewski
Jacek
J
Tracz
Wiesława
W
Pasowicz
Mieczysław
M
Zmudka
Krzysztof
K
D054058:Acute Coronary Syndrome / Q000097:blood*; D000368:Aged; D000787:Angina Pectoris / Q000097:blood; D001777:Blood Coagulation / Q000502:physiology*; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005342:Fibrinolysis / Q000502:physiology*; D006801:Humans; D007249:Inflammation / Q000097:blood*; D008297:Male; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D018384:Oxidative Stress; D010539:Permeability
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D