Key result
Dual high fibrinogen and clot strength is linked to ~51% higher 4-year post-PCI MACE risk.
Why the study?
Fibrinogen and platelet-fibrin clot strength (PFCS) are each independently associated with MACE risk, but their relationship and combined prognostic implications in patients undergoing PCI remained uncertain.
Does the combined assessment of on-admission fibrinogen and platelet-fibrin clot strength predict major adverse cardiovascular events and major bleeding in patients undergoing percutaneous coronary intervention?
Cohort (n=2,526)
Does the combined assessment of on-admission fibrinogen and platelet-fibrin clot strength predict major adverse cardiovascular events and major bleeding in patients undergoing percutaneous coronary intervention?
Combined assessment of on-admission fibrinogen and platelet-fibrin clot strength provides additive prognostic value for predicting 4-year MACE and major bleeding in patients undergoing PCI.
High fibrinogen with high clot strength associated with higher MACE; extends single-marker data but leaves combined risk stratification open.
Background Each of fibrinogen and platelet–fibrin clot strength (PFCS) is independently associated with the risk of major adverse cardiovascular events (MACE). Objective The association between fibrinogen and PFCS and their prognostic implications remains uncertain in patients undergoing percutaneous coronary intervention (PCI). Methods A total of 2,526 patients undergoing PCI, with on-admission fibrinogen and PFCS measured by thromboelastography (TEG®) was analyzed. Patients were classified according to fibrinogen (Fibrinogenhigh, defined fibrinogen > 350 mg/dL) and PFCS (PFCShigh, defined TEG®-maximal amplitude ≥ 68 mm) levels. Patients were stratified into four groups: (1) Fibrinogenlow-PFCSlow (46.0%), (2) Fibrinogenlow-PFCShigh (21.3%), (3) Fibrinogenhigh-PFCSlow (14.7%), and (4) Fibrinogenhigh-PFCShigh (17.9%). MACE was defined as composite of all-cause death, myocardial infarction, or stroke during 4-year follow-up. Results Serum fibrinogen and PFCS showed a moderate correlation (r = 0.333, P < 0.001). Fibrinogen and PFCS phenotypes had an additive prognostic implication. The Fibrinogenhigh-PFCShigh group showed significantly higher risks of MACE compared with the Fibrinogenlow-PFCShigh (adjusted hazard ratio [HRadj], 1.51; 95% confidence interval [CI], 1.04-2.20; P=0.031) and Fibrinogenhigh-PFCSlow groups (HRadj, 1.52; 95% CI, 1.01-2.27; P=0.044). Similar results were observed for all-cause death. The risk of major bleeding was significantly associated with the fibrinogen phenotype. Compared with the Fibrinogenlow-PFCSlow group, the Fibrinogenhigh-PFCSlow (HRadj, 2.89; 95% CI, 1.33-6.29; P=0.008) and Fibrinogenhigh-PFCShigh groups (HRadj, 2.40; 95% CI, 1.12-5.14; P=0.025) had significantly higher rates of major bleeding. Conclusions In PCI-treated patients, fibrinogen and P-FCS showed important prognostic associations. Their combined assessment may enhance post-PCI risk stratification and support more personalized cardiovascular therapy.
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Park et al. (2026) conducted a cohort in Coronary artery disease undergoing percutaneous coronary intervention (PCI) (n=2,526). High fibrinogen (>350 mg/dL) and high platelet-fibrin clot strength (TEG maximal amplitude ≥68 mm) (Fibrinogenhigh-PFCShigh) vs. Fibrinogenlow-PFCShigh and Fibrinogenhigh-PFCSlow groups (and Fibrinogenlow-PFCSlow) was evaluated on Major adverse cardiovascular events (MACE: composite of all-cause death, myocardial infarction, or stroke) (HR 1.51, 95% CI 1.04-2.20, p=0.031). Concomitant high fibrinogen and high clot strength increased 4-year MACE risk after PCI vs isolated high clot strength (HRadj 1.51; 95% CI 1.04-2.20) or fibrinogen (HRadj 1.52; 95% CI 1.01-2.27).
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