The Impact of platelet-fibrin clot strength on occurrence and clinical outcomes of peripheral artery disease in patients with significant coronary artery disease.

Abstract

Patients with peripheral artery disease (PAD) have shown the increased risk of cardiovascular (CV) morbidity and mortality. This study sought to evaluate the impact of clot strength on prevalence and major adverse CV events (MACE) of PAD in high-risk patients. We enrolled patients undergoing percutaneous coronary intervention (PCI) (n = 1667) with available platelet-fibrin clot strength [thrombin-induced maximal amplitude (MAthrombin) measured by thromboelastography] and inflammation [high sensitivity C-reactive protein (hs-CRP)]. PAD was defined with abnormal ankle-brachial index (≤ 0.9 or > 1.4). MACE was defined as a composite of CV death, myocardial infarction or stroke. PAD was observed in 201 patients (12.1%). In the multivariate analysis, high clot strength [MAthrombin ≥ 68 mm: odds ratio (OR) 1.70, 95% confidence interval (CI) 1.20 to 2.41, p = 0.003] and enhanced inflammation (hs-CRP ≥ 3.0 mg/L: OR 2.30, 95% CI 1.56 to 3.41, p < 0.001) were associated with PAD occurrence. During the follow-up post-PCI (median, 25 months), MACE was more frequently occurred in patients with vs. without PAD (18.7% vs. 6.4% at 3 years; hazard ratio 1.72, 95% CI 1.03 to 2.87, p = 0.039). Furthermore, combined presence of PAD and high clot strength significantly increased the risk of MACE. In conclusion, this study is the first to show the impact of clot strength on prevalence and clinical outcomes of PAD in coronary artery disease patients undergoing PCI. Whether antithrombotic strategy according to level of this biomarker can improve clinical outcomes in PAD patients deserves the further study.

• Authors: Jae Seok Bae, Jong-Hwa Ahn, Jeong Yoon Jang, Sang Young Cho, Min Gyu Kang, Kye-Hwan Kim, Hyun Woong Park, Jin-Sin Koh, Yongwhi Park, Seok-Jae Hwang, Choong Hwan Kwak, Jin-Yong Hwang, Udaya S Tantry, Paul A Gurbel, Young-Hoon Jeong
• Journal: Journal of thrombosis and thrombolysis (J Thromb Thrombolysis) Vol. 50 Issue 4 Pg. 969-981 (Nov 2020) ISSN: 1573-742X [Electronic] Netherlands
• PMID: 32279217 (Publication Type: Journal Article)

Chemical References

• Fibrin

Topics

• Ankle Brachial Index
• Blood Platelets (pathology)
• Coronary Artery Disease (blood, diagnosis, epidemiology, surgery)
• Female
• Fibrin (physiology)
• Humans
• Male
• Middle Aged
• Percutaneous Coronary Intervention (adverse effects, methods)
• Peripheral Arterial Disease (blood, diagnosis, epidemiology, physiopathology)
• Postoperative Complications (diagnosis, epidemiology, etiology)
• Prevalence
• Republic of Korea (epidemiology)
• Risk Assessment (methods)
• Severity of Illness Index
• Thrombelastography (methods)
• Thrombosis (diagnostic imaging, pathology)