Influence of hypercoagulability and impaired fibrinolysis on occurrence of acute myocardial infarction and combined prognostic implication following percutaneous coronary Interventions

Background: The underlying mechanisms of atherothrombosis comprise plaque disruption and subsequent thrombus formation, which can be modulated with systemic thrombogenicity and fibrinolytic activity. We thus sought to compare thrombogenicity indices and its prognostic implication according to the type of disease.
Methods: CAD patients undergoing percutaneous coronary intervention (PCI) were classified depending on their index clinical presentation (acute myocardial infarction [AMI] vs. non-AMI) (n=2,705). Thrombogenicity indices were measured with thromboelastography (TEG®). Major adverse cardiovascular events (MACEs) were defined as a composite of CV death, non-fatal MI, or non-fatal stroke.
Results: Compared with non-MI patients (n=1,411, 52.1%), MI patients (n=1,294, 47.9%) showed higher platelet-fibrin clot strength (PFCS) (maximum amplitude [MA]: 66.5±7.8 vs. 65.3±7.2 mm, PConclusion: AMI occurrence is significantly associated with hypercoagulability and impaired fibrinolysis. In addition, the combined phenotype increases the risk of atherothrombotic event only in AMI patients. These observations may support the clinical application of anticoagulant treatment in patient presented with AMI.