The Association of Fibrinopeptide A with Cardiac Events Following Coronary Angioplasty

Rethrombosis may be a major determinant of poor outcome after angioplasty. Fibrinopeptide A, a marker of thrombin activity, was measured in 79 patients after coronary angioplasty to assess for association with subsequent cardiac events. Fibrinopeptide A levels were drawn postangioplasty on heparin and prior to discharge off heparin. Levels greater than 2.0 ng/mL were considered elevated. During 6‐month follow‐up, recurrence of stenosis occurred in 14 out of 51 patients (27%) with elevated levels, requiring repeat angioplasty or bypass surgery. One more patient showed angiographic evidence of recurrence (at least 30% increase in stenosis) not severe enough to require revascularization. Fibrinopeptide A was elevated in this patient. There were three late cardiac deaths and one acute myocardial infarction, all in patients with elevated fibrinopeptide A. An additional five patients had an abnormal stress test without subsequent cathe‐terization to assess recurrences; four of them had elevated fibrinopeptide A. In total, there were 22 out of 51 patients (43%) with elevated fibrinopeptide A levels with adverse outcomes, as compared with 6 out of 28 (21%) with normal levels (P = 0.05). Thus, an elevated fibrinopeptide A early after angioplasty may be a marker for a group at greater risk for restenosis.