Thrombomodulin can Predict the Incidence of Second Events in Patients with Acute Myocardial Infarction

Biomarkers of atherothrombosis can predict the risk of cardiovascular events. However, it is difficult to predict second adverse events using these biomarkers at the point in time when the first cardiovascular event occurs. Therefore, we evaluated atherothrombosis-related biomarkers to determine their associations with prognosis after percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) patients. A total of 309 AMI patients were enrolled in this study. The patients had undergone successful coronary interventions and the levels of various atherothrombosis-related biomarkers were assessed within the first postoperative hour. Biomarkers other than those assessed by routine biochemical tests were analyzed, including defined endothelial cell damage markers such as thrombomodulin (TM), inflammatory markers such as C-reactive protein (CRP), and coagulation and fibrinolysis system markers such as D-dimer, prothrombin fragment F1+2 (F1+2) and plasminogen activator inhibitor-1 (PAI-1). Major adverse cardiac events (MACEs) occurred in 98 patients during the follow-up period (872.6±579.8 days). Multivariate analysis revealed that clinical parameters such as decreased levels of left ventricular ejection fraction and elevated levels of brain natriuretic peptide, hemoglobin A1c and TM were significantly associated with MACEs. The association between TM and MACEs was especially high (OR: 3.65, 95% CI; 1.75–7.68). Neither dyslipidemia, hypertension, smoking, advanced age, a history of cardiac events nor the type of AMI were associated with MACEs. TM is independently associated with MACEs and may be predictive of second events following PCI in patients with AMI.