The prognostic value of biomarkers after a premature myocardial infarction.
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.
Pineda
Javier
J
Department of Cardiology, Hospital General Universitario Alicante, Alicante, Spain. pineda_jav@gva.es
Marín
Francisco
F
Marco
Pascual
P
Roldán
Vanessa
V
Valencia
José
J
Ruiz-Nodar
Juan Miguel
JM
Romero
Diana Hernández
DH
Sogorb
Francisco
F
Lip
Gregory Y H
GY
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
D015415:Biomarkers; D001779:Blood Coagulation Factors; D008055:Lipids