Association between fibrinogen and clot strength and their prognostic implications after percutaneous coronary intervention
G Park, H Won, J Ahn, Y Jeong, J HwangAbstract
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.For image description, please refer to the figure legend and surrounding text.