The Role of Fibrinogen, Lipoprotein (a) and C-Reactive Protein in Acute Thrombotic Occlusion after Percutaneous Coronary Intervention

Jeong, Woo Kon; Jeong, Myung Ho; Lee, Sang Rok; Park, Ok Young; Yum, Ju Hyup; Kim, Won; Rhew, Jae Young; Kim, Nam Ho; Kim, Kun Hyung; Ahn, Young Keun; Kim, Sung Hwa; Cho, Jeong Gwan; Suh, Soon Pal; Ahn, Byoung Hee; Park, Jong Chun; Kim, Sang Hyung; Kang, Jung Chaee

Abstract

BACKGROUND
Acute thrombotic occlusion after percutaneous coronary intervention (PCI) is a serious complication that provokes acute myocardial infarction, cardiac death or emergent bypass surgery. The role of fibrinogen, C-reactive protein (CRP) and lipoprotein (a) [Lp(a)] in the patients who developed acute thrombotic occlusion after PCI was investigated.
METHODS
The patients with acute coronary syndrome who underwent PCI at Chonnam National University Hospital between Jan. 1999 and Jun. 2000 were divided into two groups according to the occurrence of acute thrombotic occlusion: patients with thrombotic occlusion after PCI (Group I; 62.3+/-8.8 years, M:F=19:8) and patients without thrombotic occlusion after PCI (Group II; 59.6+/-10.6 years, M:F=271:95). Clinical and angiographic characteristics, levels of fibrinogen, CRP and Lp(a) were compared between two groups.
RESULTS
There were no significant differences in the level of fibrinogen between two groups. The patients with elevated CRP (>0.5mg/dL) were more common in Group I than those in Group II (88.9% vs. 42.3%, p=0.0001) and the value of CRP was higher in Group I than in Group II (4.97+/-5.18 mg/dL vs. 2.27+/-4.23 mg/dL, p=0.002). The patients with high Lp(a) (>30mg/dL) were more prevalent in Group I than those in Group II (44.4% vs 18.6%, p=0.001). There were no significant differences in the risk factors for coronary artery disease, except for diabetes mellitus (Group I : Group II, 40.7% : 16.9%, p=0.002). Thrombolysis in Myocardial Infarction (TIMI) flow of Group I was lower than in Group II (p=0.0001). Multiple regression analysis after the adjustment for age, sex and other cardiovascular risk factors, diabetes mellitus, low TIMI flow, high CRP and Lp(a) were independently associated with the occurrence of acute thrombotic occlusion (p=0.008, 0.0001, 0.031, 0.035, respectively).
CONCLUSION
The elevated values of CRP and Lp(a), diabetes mellitus, and low TIMI flow are significant predictive factors for the acute thrombotic occlusion in patients with acute coronary syndrome after PCI.