Plasma TF activity predicts cardiovascular mortality in patients with acute myocardial infarction

doi:10.1186/1477-9560-7-11

Thrombosis Journal

Volume 7

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Steppich BA
Braun SL
Stein A
Demetz G
Groha P
Schömig A
von Beckerath N
Kastrati A
Ott I

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Steppich BA
Braun SL
Stein A
Demetz G
Groha P
Schömig A
von Beckerath N
Kastrati A
Ott I
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Original clinical investigation

Plasma TF activity predicts cardiovascular mortality in patients with acute myocardial infarction

Birgit A Steppich¹^,2 , Siegmund Lorenz Braun³ , Andreas Stein¹^,2 , Gabriele Demetz¹^,2 , Philip Groha¹^,2 , Albert Schömig¹^,2 , Nicolas von Beckerath¹^,2 , Adnan Kastrati¹^,2 and Ilka Ott¹^,2

¹Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, , Munich, Germany

²Klinik für Kardiologie, Deutsches Herzzentrum München der Technischen Universität, Munich, Germany

³Institut für Laboratoriumsmedizin, Deutsches Herzzentrum München der Technischen Universität, Munich, Germany

author email corresponding author email

Thrombosis Journal 2009, 7:11doi:10.1186/1477-9560-7-11


Published:	2 July 2009

Abstract

Objectives and Background

Tissue factor (TF) contributes to thrombosis following plaque disruption in acute coronary syndromes (ACS). Aim of the study was to investigate the impact of plasma TF activity on prognosis in patients with ACS.

Methods and Results

One-hundred seventy-four patients with unstable Angina pectoris (uAP) and 112 patients with acute myocardial infarction (AMI) were included with a mean follow up time of 3.26 years. On admission, plasma TF activity was assessed. Patients were categorized into 2 groups: a high-TF activity group with TF >24 pmol/L and low TF activity group with TF ≤ 24 pmol/L. Fifteen cardiovascular deaths occurred in the uAP group and 16 in the AMI group. In AMI TF activity was 24,9 ± 2,78 pmol/l (mean ± SEM) in survivors and 40,9 ± 7,96 pmol/l in nonsurvivors (P = 0.024). In uAP no differences were observed (25.0 ± 8.04 pmol/L nonsurvivors vs. 25.7 ± 2.14 pmol/L survivors; P = 0.586). Kaplan-Meier estimates of survival at 3.26 years regarding TF activity in AMI were 81.3% and 92.2% with an hazard ratio of 3.02 (95% CI [1.05–8.79], P = 0.03). The Cox proportional hazards model adjusting for correlates of age and risk factors showed that plasma TF activity was an independent correlate of survival (hazard ratio 9.27, 95% CI [1.24–69.12], P = 0.03). In an additional group of patients with uAP and AMI, we identified circulating microparticles as the prevailing reservoir of plasma TF activity in acute coronary syndromes.

Conclusion

Systemic TF activity in AMI has an unfavorable prognostic value and as a marker for dysregulated coagulation may add to predict the atherothrombotic risk.