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Thrombin activity throughout the acute phase of acute ST-elevation myocardial infarction and the relation to outcome

机译：急性ST段抬高型心肌梗死急性期的凝血酶活性及其与预后的关系

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摘要

Background:Thrombin and plasmin play a central role in ongoing thrombosis and platelet activation in patients with acute ST-elevation myocardial infarction (STEMI). Data of thrombin and plasmin activity in the early course of STEMI and the relation to outcome are scarce.rnMethods: We included 68 consecutive patients (53 male, 59± 11.4 years) with STEMI who underwent acute catheter-based reperfusion therapy within the first 12h after onset of symptoms. Blood samples were taken at admission and after 4,8,12 and 24 h. Thrombin activity and generation was measured by changes in the thrombin/antithrombin-III complex (TAT) and prothrombin fragment (F1.2); plasmin was measured by changes in the plasmin-α_2/antiplasmin complex (PAP). A follow-up with respect to the combined primary endpoint consisting of death, acute myocardial infarction or urgent need for revascularization up to 6 weeks post-discharge was carried out. Results:TAT values showed no significant change over time in patients with and without the primary endpoint but there was a borderline difference between these groups at 4h after admission (event group 9.0 vs no event group 4.7μg I~(-1), p = 0.057). F1.2 values were different between groups only after 24 h (event group 1.5 vs no event group 0.9 nmol I~(-1), p=0.028) and did not differ in serial sampling of 24 h. PAP values were higher in patients with events after 4 and 8h and declined over time in the group without events (p<0.001). Odds ratios (OR) with respect to the primary endpoint were highest for TAT >4.8μg I~(-1) at Oh and TAT>8.4μgI~(-1) at 4h (OR 7.1,95% confidence interval (CI) 1.5-34, p=0.015 and OR 5.5,95% Cl1.5-20.0,p=0.01, respectively). The predictive value of plasmin concentrations were equally high after 4h (PAP>962μg I~(-1)'; OR 6.8,95% Cl 1.8-26.2, p=0.005) and 8h (PAP>495μg I~(-1), OR 6.7, 95% Cl 1.4-32.9, p=0.024). Values for F1.2 were only predictive after 24 h (F1.2 >0.85 nmol I~(-1), OR 13,95% Cl 1.4-117.8, p=0.023).rnConclusions: Markers of thrombin and plasmin activity in acute STEMI are related to outcome. The marker for thrombin generation F1.2 becomes a significant predictor of outcome at 24h after admission, reflecting the potentially adverse effects of ongoing thrombin generation. This underlines the potential for direct thrombin inhibition and individualization of treatment by thrombin markers in STEMI.
机译：背景：凝血酶和纤溶酶在急性ST段抬高型心肌梗死（STEMI）患者的持续血栓形成和血小板活化中起着重要作用。方法：我们纳入了连续60例STEMI患者（前53h，男性，59±11.4岁），在前12h内接受了急性导管再灌注治疗，因此尚缺乏STEMI早期凝血酶和纤溶酶活性的数据。症状发作后。入院时，4、8、12和24小时后取血样。通过凝血酶/抗凝血酶-III复合物（TAT）和凝血酶原片段（F1.2）的变化来测量凝血酶的活性和生成。通过纤溶酶-α_2/抗纤溶酶复合物（PAP）的变化来测量纤溶酶。对于出院后6周以内的死亡，急性心肌梗塞或紧急血运重建等主要终点进行了随访。结果：在有和没有主要终点的患者中，TAT值均未随时间变化，但入院后4h这些组之间存在临界差异（事件组9.0 vs无事件组4.7μgI〜（-1），p = 0.057）。两组之间的F1.2值仅在24 h后才有差异（事件组1.5 vs无事件组0.9 nmol I〜（-1），p = 0.028），并且在24 h的连续采样中无差异。在4h和8h后发生事件的患者中PAP值较高，而在未发生事件的组中PAP值随时间下降（p <0.001）。相对于主要终点的赔率（OR）在Oh时TAT>4.8μgI〜（-1）在4h时TAT>8.4μgI〜（-1）最高（OR 7.1,95％置信区间（CI）1.5 -34，p = 0.015和OR 5.5.95％Cl1.5-20.0，p = 0.01）。纤溶酶浓度的预测值在4h（PAP>962μgI〜（-1）';或6.8,95％Cl 1.8-26.2，p = 0.005）和8h（PAP>495μgI〜（-1））后均较高。 OR 6.7，95％Cl 1.4-32.9，p = 0.024）。 F1.2的值仅在24小时后才具有预测性（F1.2> 0.85 nmol I〜（-1），或13,95％Cl 1.4-117.8，p = 0.023）。结论：急性期凝血酶和纤溶酶活性的标志物STEMI与结果有关。凝血酶生成的标志物F1.2成为入院后24h结局的重要预测指标，反映了正在进行的凝血酶生成的潜在不利影响。这突显了直接抑制凝血酶和通过STEMI中凝血酶标志物进行个性化治疗的潜力。

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  • 来源
    《Biomarkers》 |2009年第5期|311-316|共6页
  • 作者

    Natalie-Viviane Ulrich-Moeckel; Matthias Riehle; Joern Vollert; Guenther Heller Jr; Thomas Stoerk; Hanno Riess; Christian Mueller; Ulrich Frei; Martin Mockel;

  • 作者单位

    Department of Cardiology, Charite-Universitdtsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany;

    Department of Cardiology, Klinikum Augsburg Germany;

    Department of Cardiology, Charite-Universitdtsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany;

    Scientific Institute, AOK Bonn, Germany;

    Department of Cardiology, Karl Olga Hospital, Stuttgart, Germany;

    Department of Uematology/Oncology, Charite- Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany;

    Department of Clinical Chemistry, Charite- Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany;

    Department of Nephrology/Intensive Care Medicine, Charite-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany;

    Department of Cardiology, Charite-Universitdtsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany;

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  • 原文格式 PDF
  • 正文语种 eng
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  • 关键词

    STEMI; reperfusion therapy; thrombin; major cardiac events;

    机译：STEMI;再灌注疗法凝血酶重大心脏事件;

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