title: Effect of Serum Fibrinogen, Total Stent Length, and Type of Acute Coronary Syndrome on 6-Month Major Adverse Cardiovascular Events and Bleeding After Percutaneous Coronary Intervention.
abstract: This study evaluated the relation between baseline fibrinogen and 6-month major adverse cardiovascular events (MACE) and bleeding after percutaneous coronary intervention (PCI). Three hundred eighty-seven subjects (65.6 ± 16.1 years, 69.5% men, 26.9% acute coronary syndrome [ACS]) who underwent PCI with baseline fibrinogen and platelet reactivity (VerifyNow P2Y12 assay, Accumetrics, San Diego, California) measured were enrolled. Fibrinogen (368.8 ± 144.1 vs 316.8 ± 114.3 mg/dl; p = 0.001), total stent length (TSL; 44.5 ± 25.0 vs 32.2 ± 20.1 mm; p <0.001), and ACS presentation (40.6% vs 23.9%; p = 0.005) were independently associated with 6-month MACE rates (17.8%: myocardial infarction 9.8%, rehospitalization for ACS 3.6%, urgent revascularization 3.6%, stroke 0.5%, and death 0.3%). Measures of platelet reactivity were not associated with 6-month MACE. After multivariate analysis, fibrinogen ≥280 mg/dl (odds ratio [OR] 2.60, 95% CI 1.33 to 5.11, p = 0.005), TSL ≥32 mm (OR 3.21, 95% CI 1.82 to 5.64, p <0.001), and ACS presentation (OR 2.58, 95% CI 1.45 to 4.61, p = 0.001) were associated with higher 6-month MACE. In 271 subjects receiving chronic P2Y12 inhibitor therapy, 6-month Thrombolysis In Myocardial Infarction bleeding after PCI was 7.0%, but no difference in fibrinogen level (338.3 ± 109.7 vs 324.3 ± 113.8 mg/dl, p = 0.60) stratified by Thrombolysis In Myocardial Infarction bleeding was observed. In conclusion, elevated serum fibrinogen, ACS presentation, and longer TSL are independently associated with higher 6-month MACE after PCI, whereas no association with on-thienopyridine platelet reactivity and 6-month MACE was observed. Post-PCI bleeding was not associated with lower fibrinogen level.
authors.affiliation: Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California. Electronic address: emahmud@ucsd.edu.
authors.forename: Ehtisham
authors.initials: E
authors.lastname: Mahmud
authors.affiliation: Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California.
authors.forename: Mattheus
authors.initials: M
authors.lastname: Ramsis
authors.affiliation: Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California.
authors.forename: Omid
authors.initials: O
authors.lastname: Behnamfar
authors.affiliation: Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California.
authors.forename: Kelly
authors.initials: K
authors.lastname: Enright
authors.affiliation: Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California.
authors.forename: Andrew
authors.initials: A
authors.lastname: Huynh
authors.affiliation: Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California.
authors.forename: Khushboo
authors.initials: K
authors.lastname: Kaushal
authors.affiliation: Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California.
authors.forename: Samhita
authors.initials: S
authors.lastname: Palakodeti
authors.affiliation: Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California.
authors.forename: Shiqian
authors.initials: S
authors.lastname: Li
authors.affiliation: Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California.
authors.forename: Phildrich
authors.initials: P
authors.lastname: Teh
authors.affiliation: Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California.
authors.forename: Felice
authors.initials: F
authors.lastname: Lin
authors.affiliation: Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California.
authors.forename: Ryan
authors.initials: R
authors.lastname: Reeves
authors.affiliation: Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California.
authors.forename: Mitul
authors.initials: M
authors.lastname: Patel
authors.affiliation: Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Ang
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000601:surgery*; D000368:Aged; D002140:California / Q000453:epidemiology; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D019106:Postoperative Hemorrhage / Q000097:blood / Q000453:epidemiology*; D011379:Prognosis; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate / Q000639:trends; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D013997:Time Factors
chemical_list: D005343:Fibrinolytic Agents; D005340:Fibrinogen