| Background and Objective:Nowadays, coronary heart disease (CHD) keeps the leading cause ofhospitalization in Cardiology department, It is one of the main factors endangeringhuman’s health and mortality. CHD includes chronic ischemia syndrome and acutecoronary syndrome (ACS). Among them, ACS especially keeps the biggest threat onhuman’s health and safety. ACS is a clinical syndrome which was caused by acutemyocardial ischemia. It is a severe type of CHD, including unstable angina (UA),non-ST-segment elevation myocardial infarction (NSTEMI), ST-segment elevationmyocardial infarction (STEMI). Coronary artery spasm or complete or incompleteblock, on the basis of coronary artery atherosclerosis, is the reason why the patientswith ACS have an emergency. The rapid restoration of myocardial blood supply is thefirst goal when treat with the patients with ACS. The methods include thrombolytictherapy, percutaneous coronary intervention (PCI) and coronary artery bypassgrafting (CABG). Previous studies have confirmed that PCI is an effective method inthe treatment of ACS. In the aspect of saving the lives of patients, improving thequality of life, prolonging the life span of the patients, compared with othertreatments, PCI has obvious advantages. However there is still a very high ratio ofin-stent restenosis (ISR) after PCI. Stratifying the risk reasonably, searching for an ideal index to judge the prognosis of the patients after PCI in order to make theintervention measures in advance is urgent to solve.Fibrinogen(FIB) is a glycoprotein synthesized by the liver, molecular weight of340000. It consists of alpha, beta, gamma three pairs of polypeptide chain with twodisulfide bond. The initial researches have found that it plays a very important role inthe blood coagulation process. By the digestion of thrombin, FIB alpha and betachains release A and B peptide, and then A and B peptide generate the fibrin monomerⅠ and fibrin monomer Ⅱ. At last, fibrin monomer cross-links together to form asolid insoluble fibrin. More and more researches in recent years have found that FIBnot only involves in blood clotting, but also plays an important role in ACSoccurrence, development process. The mechanism is not clear, but studies haveshown that local coronary artery inflammation can cause inflammatory mediators,such as IL-6, IL-1β and TNF-α, stimulate the liver synthesis and secretion of FIBincreased, which lead to a high level concentration of FIB. The increase of FIBconcentration can lead the body to a hypercoagulable state. Moreover, it can enhancethe firmness of thrombosis. But the relevance of plasma FIB level to the prognosis inpatients suffering ACS undergoing PCI is not clear. The aim of this study is toinvestigate the prognostic value of plasma FIB level in patients with ACS undergoingPCI.Method:This study was a prospective study. A total of1094patients treated with PCI inCardiology department, the First Affiliated Hospital of Zhengzhou University wereenrolled in the study from June2009to December2010. In the first24hours afteradmission, patients’ fasting plasma FIB and other relevant clinical data were collected.The patients were followed by calling or in out-patient department from August toNovember,2012. The primary end point was all-cause mortality. Another PCI, acutemyocardial infarction, coronary artery bypass grafting or readmission for anginapectoris, heart failure or stroke was included in the secondary end points events. Thepatients were divided into four groups according to their plasma FIB level: G1:FIB＜ 2.95g/L, G2:2.95g/L≤FIB＜3.39g/L, G3:3.39g/L≤FIB＜4.01g/L, G4:FIB≥4.01g/L. Application of univariate and multivariate logistic regression analyses to explorefactors associated with the prognosis. The survival rate was estimated by Kplan-Meier survival curve. P＜0.05was considered as statistically significant difference.Results:1．990patients (90.5%) were eventually followed-up. The mean followed-uptime was (29.3±4.7)months.170cases of adverse events occurred (17.2%),27patients(2.7%) suffered death ultimately.2．One-way ANOVA showed that FIB, bilirubin, diabetes, hypertension, E peak,the time of oral administration of aspirin or clopidogrel less than1year after PCI,without treated with angiotensin-converting enzyme inhibitor (ACEI) or angiotensionⅡ receptor blocker (ARB) or statins, smoking were risk factors of occurrence ofendpoint. The distribution of them was significant between without endpoint groupand endpoint group. P values were less than0.05.3．The level of FIB in without endpoint group (3.43±0.75g/L) was significantlylower than the endpoint group (3.74±0.99g/L). Male patients (3.40±0.81g/L) had alower level of FIB than female patients (3.66±0.77g/L). Diabetes (3.58±0.84g/L)had a lower level of FIB than those patients without a history of diabetes (3.41±0.77g/L). The difference is statistical significance. P values were less than0.05.4．Pearson correlation analysis showed that FIB was positively correlated withwhite blood cell(WBC), Cystatin C (Cys C), Lipoprotein-a(LPa), high sensitive Creactive protein(HS-CRP), diabetes, the time of oral administration with aspirin orclopidogrel less than1year after PCI. FIB was negatively correlated withwithout-treatment of statins. This indicates that the level of FIB in diabetes is higher,and that the oral administration of statins can decrease the level of FIB.5．The incidences of total end point events were significantly increased with theincreasing of plasma FIB level in the four groups(12.2%,14.9%,20.2%,22.8%, χ2＝11.937, P＝0.008).6．The results of multiple regression logistic analysis（.1） The high level of FIB is an independent risk factor for the occurrence of endpoint after PCI. The incidencesof total end point events in G3group are increased by1.611times (OR＝1.611,95%CI:1.075～2.414, P＝0.021), and1.616times in G4group, compared with G1group. The level of fibrinogen is affected by gender and diabetes. By adjusting thesetwo factors, fibrinogen is still a risk factors of the occurrence of endpoint (r＝0.132,P＜0.0001);（2）The higher level of bilirubin is a protective factor for decreasing theoccurrence of endpoint after PCI. Compared with the lower level of bilirubin, Theincidences of total end point events in higher level of bilirubin group are decreased by0.642times(OR＝0.642,95%CI:0.434～0.950, P＝0.027).（3）Hypertension is anindependent risk factor for the occurrence of endpoint after PCI. The incidences oftotal end point events in hypertension are increased by1.579times (OR＝1.579,95%CI:1.083～2.302, P＝0.017), compared with the patients without hypertension.（4）It is an independent risk factors for the occurrence of endpoint after PCI that Thetime of oral administration with clopidogrel was less than1year(OR＝3.507,95%CI:1.582～7.777, P＜0.001).7．Kaplan-Meier survival curve analysis showed that there were significantdifferences in calculative survival rates without adverse events between the fourgroups(P＝0.02).Conclusion:The levels of fasting plasma FIB could be considered as a predictor of theoccurance of endpoint events in patients with ACS after PCI. Decreased FIB levels inpatients with ACS after PCI maybe an effective way to improve the prognosis. |
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