Fibrinogen and Intracoronary Thrombus as Predictors of Major Adverse Cardiovascular Events In-Hospital in St-Elevation Myocardial Infarction (STEMI) Patients Undergoing Primary Percutaneous Coronary Intervention

Abstract

Background: Fibrinogen is an acute phase reactant involved in inflammation and coagulation in STEMI. Rupture of atherosclerotic plaque can cause the formation of intracoronary thrombus. Despite undergoing primary percutaneous coronary intervention (PCI), patients are at risk of experiencing major adverse cardiovascular events (MACE). Method: The research design used a prospective cohort. The independent variables are fibrinogen and intracoronary thrombus. Fibrinogen levels are examined when the patient arrives at the cardiac emergency unit. Intracoronary thrombus examination is carried out when the patient undergoes primary PCI. The outcomes studied were MACE during treatment in the form of cardiovascular death, cardiogenic shock, acute heart failure, malignant arrhythmias and persistent chest pain. Results: A total of 62 samples were involved in this research. There were 29 patients (46.7%) with high fibrinogen and 38 patients (61.3%) with large intracoronary thrombus. During follow-up during treatment, 26 patients (41.9%) experienced MACE. The cut-off fibrinogen value was 341.6 mg dl (AUC 0.809; 95% CI 0.696-0.923; p<0.001). Cox regression analysis using the backward log rank method showed that high fibrinogen (adjusted HR 3.45; 95% CI 1.29-9.23; p=0.13) and large intracoronary thrombus (adjusted HR 4.30; 95% CI 1.24-14.90; p=0.021) were independent predictors of MACE during hospitalization. Combined analysis of high fibrinogen and large intracoronary thrombus showed that 81.0% of patients experienced MACE during hospitalization (adjusted RR 2.87; 95% CI 1.12-7.35; Cohran and Mantel-Haenzel p=0.002). Conclusion: High fibrinogen and large intracoronary thrombus are independent predictors of MACE during hospitalization and can be applied as additional data for risk stratification in STEMI patients undergoing primary PCI.