Emerging prognostic factors in ischemic heart disease

Abstract number: P0428

Brogi D., Sofi F., Marcucci R., Fedi S., Cellai A. P., Gensini F., Sestini I., Giuello A., Gazzini A., Abbate R., Gensini G. F.

University of Florence, Italy

A lot of recent data indicate that emerging haemostatic-related factors have an important role in the pathogenesis of coronary artery disease but their prognostic value in patients with CAD have not been defined yet. Aim of our study was to evaluate the prognostic value of emerging genetic and metabolic hemostasis-related risk factors in a group of consecutive patients with angiographic diagnosis of CAD who were referred to the Coronary Intensive Therapy Unit of the University of Florence. We investigated, on blood samples obtained at the time of admission, the presence of Factor V Leiden and prothrombin G20210A mutations, homocysteine (Hcy), lipoprotein (a) [Lp(a)] and plasminogen activator inhibitor 1 (PAI-1) plasma levels in a group of patients and in 300 healthy subjects recruited from the blood donors of our hospital. Metabolic factors were significantly different in patients if compared with controls. Hyperomocysteinemia, defined as a concentration of Hcy above the 95th percentile of controls, was diagnosed in 160/416 patients (38.5%) and in 15/300 controls (5%); lipoprotein (a) levels above 300 mg dL^-1, cut-off of cardiovascular risk, were present in 146/416 patients (35.1%) and in 41/416 controls and PAI-1 > 15 IU mL^-1 in 204/416 patients (49%) and in 53/300 controls (17.7%). There was no statistically significant difference concerning the presence of the two investigated mutations in patients compared to controls: prothrombin G20210 A was present in 18/416 patients (4.3) and in 6/300 controls (2%) and factor V Leiden in 16/416 patients (3.8%) and 12/300 controls (4%). Patients were followed for a mean period of 15 months (range: 4–26): 123/416 had a clinical recurrence (12.2% AMI, 33.3% unstable angina and 54.5% stable angina). 41/416 died for cardiovascular causes. 26/41 deceased patients had elevated PAI-1 levels (63.4%) and 26/41 hyperhomocysteinemia (63.3%). At the multivariate analysis, adjusted for the classical and hemostasis-related risk factors and also for the number of vessels with a stenosis >75%, hyperhomocysteine and high PAI-1 levels resulted independent predictive factors for cardiovascular mortality (hyperhomocysteinemia: OR = 2.9, 95%CI = 1.5–5.9, P < 0.002; PAI-1: OR = 2.1 95%CI = 1–4.2, P = 0.004). This study reveals that elevated homocysteine plasma levels and high levels of PAI-1 could be predictors for cardiovascular mortality in patient with CAD.