Prognostic impact of hypercoagulability and impaired fibrinolysis in acute myocardial infarction

Seung Hun Lee, Hyun Kuk Kim, Jong-Hwa Ahn, Min Gyu Kang, Kye-Hwan Kim, Jae Seok Bae, Sang Young Cho, Jin-Sin Koh, Yongwhi Park, Seok Jae Hwang, Diana Gorog, Udaya S. Tantry, Kevin P. Bliden, Paul A Gurbel, Jin-Yong Hwang, Young-Hoon Jeong

Research output: Contribution to journalArticlepeer-review


AIMS: Atherothrombotic events are influenced by systemic hypercoagulability and fibrinolytic activity. The present study evaluated thrombogenicity indices and their prognostic implications according to disease acuity.
METHODS AND RESULTS: From the consecutive patients undergoing percutaneous coronary intervention (PCI), those with thrombogenicity indices (n = 2705) were grouped according to disease acuity [acute myocardial infarction (AMI) vs. non-AMI]. Thrombogenicity indices were measured by thromboelastography (TEG). Blood samples for TEG were obtained immediately after insertion of the PCI sheath, and TEG tracing was performed within 4 h post-sampling. Major adverse cardiovascular events (MACE, a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke) were evaluated for up to 4 years. Compared with non-AMI patients, AMI patients had higher platelet-fibrin clot strength [maximal amplitude (MA): 66.5 ± 7.8 vs. 65.3 ± 7.2 mm, P < 0.001] and lower fibrinolytic activity [clot lysis at 30 min (LY30): 0.9 ± 1.8% vs. 1.1 ± 1.9%, P < 0.001]. Index AMI presentation was associated with MA [per one-mm increase: odds ratio (OR): 1.024; 95% confidence interval (CI): 1.013-1.036; P < 0.001] and LY30 (per one% increase: OR: 0.934; 95% CI: 0.893-0.978; P = 0.004). The presence of high platelet-fibrin clot strength (MA ≥68 mm) and low fibrinolytic activity (LY30 < 0.2%) was synergistically associated with MACE occurrence. In the multivariable analysis, the combined phenotype of 'MA ≥ 68 mm' and 'LY30 < 0.2%' was a major predictor of post-PCI MACE in the AMI group [adjusted hazard ratio (HR): 1.744; 95% CI: 1.135-2.679; P = 0.011], but not in the non-AMI group (adjusted HR: 1.031; 95% CI: 0.499-2.129; P = 0.935).
CONCLUSION: AMI occurrence is significantly associated with hypercoagulability and impaired fibrinolysis. Their combined phenotype increases the risk of post-PCI atherothrombotic event only in AMI patients. These observations may support individualized therapy that targets thrombogenicity for better outcomes in patients with AMI.
CLINICAL TRIAL REGISTRATION: Gyeongsang National University Hospital (G-NUH) Registry, NCT04650529.
Original languageEnglish
Pages (from-to)1718-1728
Number of pages11
JournalEuropean Heart Journal
Issue number19
Early online date1 Mar 2023
Publication statusPublished - 14 May 2023


  • acute myocardial infarction
  • atherothrombosis
  • fibrinolysis
  • hypercoagulability


Dive into the research topics of 'Prognostic impact of hypercoagulability and impaired fibrinolysis in acute myocardial infarction'. Together they form a unique fingerprint.

Cite this