title: The prognostic value of biomarkers after a premature myocardial infarction.
abstract: BACKGROUND
  Intravascular thrombogenesis is influenced by a complex interplay of factors related to a procoagulant state, fibrinolysis, endothelial damage/dysfunction and inflammation. We hypothesised that abnormalities of these biological systems would contribute to outcome of coronary artery disease presenting at a young age.
  
  
  METHODS
  We performed a prospective study of 142 subjects presenting with acute myocardial infarction (AMI) at a young age (defined as age ≤45 years), to determine the clinical and laboratory predictors of cardiovascular events during 36 months of follow-up. We assessed conventional risk factors and abnormalities of thrombophilia [total homocysteine (tHcy), lipoprotein (a) [Lp(a)], antiphospholipid antibodies (APA)], as well as lipid profile (total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides), fibrinogen and fibrin D-dimer (as indices of a hypercoagulable state and thrombogenesis), von Willebrand factor (vWF, an index of endothelial damage/dysfunction), tissue plasminogen activator [t-PA antigen] and its inhibitor [PAI-1 antigen] (as indices of fibrinolysis), and C-reactive protein [CRP] (an index of inflammation).
  
  
  RESULTS
  In a multivariate analysis, the variables independently associated with cardiovascular events at follow-up were levels of homocysteine (OR 3.73, 95% CI (1.54-9.02); p=0.003), left ventricle systolic dysfunction (OR 3.04, 95% CI (1.00-9.25); p=0.050), and smoking habit (OR 2.79, 95% CI (1.09-7.14) p=0.032).
  
  
  CONCLUSIONS
  Prognostic markers associated with cardiovascular events in premature CAD (young AMI subjects) were cigarette smoking and EF<50% of left ventricle as conventional clinical risk factors, as well as higher levels of homocysteine.
authors.affiliation: Department of Cardiology, Hospital General Universitario Alicante, Alicante, Spain. pineda_jav@gva.es
authors.forename: Javier
authors.initials: J
authors.lastname: Pineda
authors.forename: Francisco
authors.initials: F
authors.lastname: Marín
authors.forename: Pascual
authors.initials: P
authors.lastname: Marco
authors.forename: Vanessa
authors.initials: V
authors.lastname: Roldán
authors.forename: José
authors.initials: J
authors.lastname: Valencia
authors.forename: Juan Miguel
authors.initials: JM
authors.lastname: Ruiz-Nodar
authors.forename: Diana Hernández
authors.initials: DH
authors.lastname: Romero
authors.forename: Francisco
authors.initials: F
authors.lastname: Sogorb
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
mesh_terms: D000328:Adult; D017668:Age of Onset; D015415:Biomarkers / Q000097:blood*; D001779:Blood Coagulation Factors / Q000378:metabolism; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008055:Lipids / Q000097:blood; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D019851:Thrombophilia / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D001779:Blood Coagulation Factors; D008055:Lipids