Hemostatic derangements in diverse atherosclerotic cardiovascular disease presentations

Abstract Background Hypercoagulability is a major determinant of atherosclerosis but differences between atherosclerotic cardiovascular diseases (ASCVD) presentations remain understudied. Purpose The aim of the study was to investigate the differences in hemostasis between apparently healthy individuals, patients with stable coronary artery disease (CAD), patients with peripheral artery disease (PAD), and patients after myocardial infarction (AMI). Methods For this cross-sectional study we recruited consecutive individuals i) referred for coronary computed tomography angiography (CCTA) due to suspected coronary artery disease; ii) referred for endovascular procedures due to PAD, and iii) referred for cardiac rehabilitation 90 days after myocardial infarction. Apparently healthy individuals were defined as individuals with no signs of CAD on CCTA. Overall hemostatic potential (OHP) and overall coagulation potential (OCP) were determined from a peripheral blood sample according to previously described protocol. Overall fibrinolytic potential (OFP) was calculated with the formula: OFP = (OHP – OCP)/OCP × 100 (%), as per protocol. Between-group differences were assessed using one-way ANOVA for normally distributed variables, Kruskall-Wallis for non-normally distributed variables, and the χ2 test for categorical variables/proportions. Pairwise comparisons were adjusted using Bonferroni method for multiple testing. Results A total of 436 patients (36.9 % were women, mean age was 62.7 ± 10.8 years) were included: 66 (15.1%) apparently healthy individuals, 105 (24.1%) participants with stable CAD, 155 (35.6%) participants with myocardial infarction, and 110 (25.2%) participants with symptomatic PAD (table 1). Apparently healthy individuals were younger, predominantly women, with lower proportion of traditional cardiovascular risk factors but for a higher presence of family history, higher total, LDL and HDL cholesterol levels and had less often statin therapy prescribed (table). Hemostasis measurements differed between groups: OHP was the lowest in healthy participants and patients with stable CAD, higher in patients with myocardial infarction, and highest in patients with PAD (figure). OCP was higher in patients with myocardial infraction compared to the other groups (figure). OFP was the highest in healthy participants and patients with myocardial infarction, lower in patients with stable CAD, and lowest in patients with PAD (figure). Conclusion Our study has shown that patients with ASCVD are prone to coagulation in comparison to healthy individuals with different imbalances: patients with stable CAD and PAD have decreased fibrinolysis while patients after AMI have increased coagulation.FigureFor image description, please refer to the figure legend and surrounding text. TableFor image description, please refer to the figure legend and surrounding text.