Predictors of myocardial infarction in patients with stable peripheral artery disease

Objective. To study blood clotting factors (von Willebrand factor, factors VIII, IX, XI) as possible predictors of unfavorable outcomes, particularly, myocardial infarction, in patients with chronic lower limb ischemia due to stable peripheral artery disease. Material and methods. The study included 52 patients, median age was 61 (55; 66) years; 42 (82.7%) patients were male. Within a year, 3 (6%) patients were newly diagnosed with cancer; 4 (8%) patients developed myocardial infarction. There were no cases of lower limb thrombosis, stroke or lethal outcomes. Results. vWF and factor IX activity was increased up to 300% (160; 300) and 175% (124; 239), respectively. However, it was not associated with any of the aforementioned outcomes (p>0.05). Subjects with factor XI activity over 142% had a 9-fold higher risk of myocardial infarction (RR 9, CI 95% 1.023—79.171). Patients with previous myocardial infarction had a 2.6-fold higher risk of repeated infarction within a year (RR 2.6, CI 95% 1.031—6.599). Conclusion. In patients with stable peripheral atherosclerosis, activity of vWF and factor IX is increased. The probability of acute myocardial infarction in patients with intermittent claudication depends on baseline activity of factor XI (higher activity of factor XI means higher probability of myocardial infarction). Previous infarction in patients with peripheral atherosclerosis increases the risk of recurrent myocardial infarction.