Association of in vitro measures of clot formation, platelet function, and fibrinolysis with coronary blood flow and clinical outcomes in acute myocardial infarction

Background The patency of the infarct-related artery (IRA) is known to be associated with clinical outcomes in acute myocardial infarction (AMI). It is known that the presence of impaired coronary blood flow in the acute phase of the disease may worsen the course of the AMI. Despite its great importance, the precise determinants of the IRA blood flow remain incompletely understood. Methods A total of 255 AMI patients were included in this study: 169 with impaired (TIMI 0-I) and 86 with preserved (TIMI II-III) coronary blood flow. All patients underwent complete hemostasis profiling, including rotational thromboelastometry, impedance aggregometry and thrombodynamics and were assessed for various in- and out-of-hospital AMI-related complications. Results TIMI 0-I patients were characterized by an enhanced in vitro prothrombotic profile compared with TIMI II-III patients . We identified an association between several hemostatic parameters and impaired coronary blood flow (shorter clotting time (CT); higher platelet aggregation values induced by arachidonic acid, ADP and TRAP-6; higher clot amplitudes (A20 and A25), higher clot density (D) and initial clot growth rate (Vi)). We also found that AUC TRAP-6, CT, and Vi were associated with the rate of in-hospital complications, whereas clot amplitude (A25) was linked to the frequency of out-of-hospital complications Conclusion The present study identified several hemostatic parameters associated with both IRA patency and clinical course of AMI. These findings indicate a more pronounced prothrombotic state in patients with reduced coronary blood flow, and further research is required to translate these findings into clinical practice.