Key result
Elevated peri-PTCA fibrinogen is linked to ~17-fold higher 6-month MACCE rates.
Cohort (n=80)
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Shows that elevated periprocedural plasma fibrinogen predicts major adverse cardiac events after coronary stenting, highlighting its utility for risk assessment.
Objective: The advancement in percutaneous transluminal coronary angioplasty (PTCA) has led to it becoming the predominant mode of revascularization. Post PTCA adverse events in the form of stent thrombosis, recurrent ischemia, unplanned revascularization, recurrent hospitalization etc. result in morbidity as well as mortality. Biomarkers predicting such outcomes can be useful in initiating more aggressive medical therapy and greater modification of risk factors. This study was undertaken to study the predictive significance of periprocedural plasma fibrinogen levels for coronary stenting outcomes. Methods: 80 patients diagnosed as either chronic stable angina (CSA), unstable angina (UA), Non ST Elevation Myocardial Infarction (NSTEMI) or late presentation ST Elevation Myocardial Infarction (STEMI) undergoing planned PTCA were included in study. Patients were evaluated for clinical history, electrocardiogram (ECG), two dimensional echocardiography (2D-echo) and cardiac biomarkers (Creatinine Phosphokinase-MB isomer (CK-MB) and Troponin I). Serum fibrinogen level was measured 24 hours prior to PTCA along with routine pre-operative investigations; and also 24 hours after coronary stenting. Patients were followed for six months. Outcome measure was taken to be freedom from cardiac related adverse events, including rehospitalization, unplanned repeat revascularization, definite stent thrombosis, transient ischemic attack, stroke and all-cause mortality. Results: Fibrinogen level ≥393 mg/dL, 24 hours prior to percutaneous transluminal coronary angioplasty, was associated with higher major adverse cardiac and cerebrovascular events (MACCE) rates (60%) as compared to those with fibrinogen level <393 mg/dL (3.6%). Fibrinogen level ≥427 mg/dL 24 hours after percutaneous transluminal coronary angioplasty, was associated with higher major adverse cardiac and cerebrovascular events rates (65%) as compared to those with fibrinogen level <427 mg/dL (6.7%). Conclusion: The current study demonstrates that higher baseline and post procedural fibrinogen, is an independent predictor of 6 months major adverse cardiac and cerebrovascular events after elective percutaneous coronary intervention.
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Bansal et al. (2022) conducted a cohort in Coronary artery disease undergoing planned percutaneous transluminal coronary angioplasty (PTCA) (n=80). Elevated periprocedural plasma fibrinogen (≥393 mg/dL pre-PTCA or ≥427 mg/dL post-PTCA) vs. Lower periprocedural plasma fibrinogen (<393 mg/dL pre-PTCA or <427 mg/dL post-PTCA) was evaluated on Major adverse cardiac and cerebrovascular events (MACCE), including rehospitalization, unplanned repeat revascularization, definite stent thrombosis, transient ischemic attack, stroke, and all-cause mortality. Elevated pre-PTCA and post-PTCA plasma fibrinogen levels predicted higher 6-month MACCE rates compared to lower levels.
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