The Impact of platelet-fibrin clot strength on occurrence and clinical outcomes of peripheral artery disease in patients with significant coronary artery disease.
Jae Seok BaeJong-Hwa AhnJeong Yoon JangSang Young ChoMin Gyu KangKye-Hwan KimHyun Woong ParkJin-Sin KohYongwhi ParkSeok-Jae HwangChoong Hwan KwakJin-Yong HwangUdaya S TantryPaul A GurbelYoung Hoon JeongPublished in: Journal of thrombosis and thrombolysis (2021)
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.
Keyphrases
- coronary artery disease
- percutaneous coronary intervention
- patients undergoing
- end stage renal disease
- peripheral artery disease
- acute coronary syndrome
- ejection fraction
- newly diagnosed
- atrial fibrillation
- st segment elevation myocardial infarction
- coronary artery bypass grafting
- antiplatelet therapy
- oxidative stress
- st elevation myocardial infarction
- type diabetes
- peritoneal dialysis
- left ventricular
- brain injury
- blood brain barrier
- subarachnoid hemorrhage
- aortic valve
- resistance training
- transcatheter aortic valve replacement
- drug induced
- diabetic rats