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Hemostatic risk factors in patients with coronary artery disease and type 2 diabetes - a two year follow-up of 243 patients.

Jax TW, Peters AJ, Plehn G, Schoebel FC - Cardiovasc Diabetol (2009)

Bottom Line: Patients with clinical events were found to be more frequently diabetic and presented with a more progressed coronary atherosclerosis.The results were also unfavorable for the incidence of acute cardiovascular events (18% vs. 8%, p < 0.01).In comparison to non-diabetic patients diabetics demonstrated significantly elevated levels of fibrinogen (352 +/- 76 vs. 312 +/- 64 mg/dl, p < 0.01), plasma viscosity (1.38 +/- 0.23 vs. 1.31 +/- 0.16 mPas, p < 0.01), red blood cell aggregation (13.2 +/- 2.5 vs. 12.1 +/- 3.1 E, p < 0.05) and plasmin-activator-inhibitor (6.11 +/- 3.4 vs. 4.7 +/- 2.7 U/l, p < 0.05).

View Article: PubMed Central - HTML - PubMed

Affiliation: Medizinische Klinik und Poliklinik B, Klinik für Kardiologie, Pneumologie und Angiologie, Heinrich-Heine-Universität, Duesseldorf, Germany. thomas.jax@profil-research.de

ABSTRACT

Background: Thrombosis is regarded to be a key factor in the development of acute coronary syndromes in patients with coronary artery disease (CAD). We hypothesize, that hemostatic and rheological risk factors may be of major relevance for the incidence and the risk stratification of these patients.

Methods: In 243 patients with coronary artery disease and stable angina pectoris parameters of metabolism, hemostasis, blood rheology and endogenous fibrinolysis were assessed. Patients were prospectively followed for 2 years in respect to elective revascularizations and acute coronary syndromes.

Results: During follow-up 88 patients presented with cardiac events, 22 of those were admitted to the hospital because of acute events, 5 Patients were excluded due to non- cardiac death. Patients with clinical events were found to be more frequently diabetic and presented with a more progressed coronary atherosclerosis. Even though patients with diabetes mellitus demonstrated a comparable level of multivessel disease (71% vs. 70%) the rate of elective revascularization was higher (41% vs. 28%, p < 0.05). The results were also unfavorable for the incidence of acute cardiovascular events (18% vs. 8%, p < 0.01). In comparison to non-diabetic patients diabetics demonstrated significantly elevated levels of fibrinogen (352 +/- 76 vs. 312 +/- 64 mg/dl, p < 0.01), plasma viscosity (1.38 +/- 0.23 vs. 1.31 +/- 0.16 mPas, p < 0.01), red blood cell aggregation (13.2 +/- 2.5 vs. 12.1 +/- 3.1 E, p < 0.05) and plasmin-activator-inhibitor (6.11 +/- 3.4 vs. 4.7 +/- 2.7 U/l, p < 0.05).

Conclusion: Pathological alterations of fibrinogen, blood rheology and plasminogen-activator-inhibitor as indicators of a procoagulant state are of major relevance for the short-term incidence of cardiac events, especially in patients with diabetes mellitus type 2, and may be used to stratify patients to specific therapies.

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clinical events in 243 patients. Elective revascularizations include aorto-coronary bypass operation and angioplasty, acute events include unstable angina pectoris, acute myocardial infarction and cardiac death.
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Figure 1: clinical events in 243 patients. Elective revascularizations include aorto-coronary bypass operation and angioplasty, acute events include unstable angina pectoris, acute myocardial infarction and cardiac death.

Mentions: Out of 264 originally selected patients a clinical course after 2 years could be documented in 243 patients. Thus the feed back rate was 91.3%. Patient characteristics are given in table 1. Per definition in 150 patients there was no cardiovascular event. Three patients died from non- cardiac disease. Within the follow up period 88 patients developed a cardiovascular event. 66 of them underwent elective revascularization (figure 1). Of those 44 underwent PTCA and 22 ACB bypass surgery. 22 patients suffered from an acute cardiovascular event: 11 from an unstable angina pectoris, 8 from an acute myocardial infarction and 3 from a cardiac death. Related to the observed group (n = 241) these figures correspond to an elective rate of revascularization of 27,3% (PTCA, ACB) and to an acute rate of events of 9,1%.


Hemostatic risk factors in patients with coronary artery disease and type 2 diabetes - a two year follow-up of 243 patients.

Jax TW, Peters AJ, Plehn G, Schoebel FC - Cardiovasc Diabetol (2009)

clinical events in 243 patients. Elective revascularizations include aorto-coronary bypass operation and angioplasty, acute events include unstable angina pectoris, acute myocardial infarction and cardiac death.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2743654&req=5

Figure 1: clinical events in 243 patients. Elective revascularizations include aorto-coronary bypass operation and angioplasty, acute events include unstable angina pectoris, acute myocardial infarction and cardiac death.
Mentions: Out of 264 originally selected patients a clinical course after 2 years could be documented in 243 patients. Thus the feed back rate was 91.3%. Patient characteristics are given in table 1. Per definition in 150 patients there was no cardiovascular event. Three patients died from non- cardiac disease. Within the follow up period 88 patients developed a cardiovascular event. 66 of them underwent elective revascularization (figure 1). Of those 44 underwent PTCA and 22 ACB bypass surgery. 22 patients suffered from an acute cardiovascular event: 11 from an unstable angina pectoris, 8 from an acute myocardial infarction and 3 from a cardiac death. Related to the observed group (n = 241) these figures correspond to an elective rate of revascularization of 27,3% (PTCA, ACB) and to an acute rate of events of 9,1%.

Bottom Line: Patients with clinical events were found to be more frequently diabetic and presented with a more progressed coronary atherosclerosis.The results were also unfavorable for the incidence of acute cardiovascular events (18% vs. 8%, p < 0.01).In comparison to non-diabetic patients diabetics demonstrated significantly elevated levels of fibrinogen (352 +/- 76 vs. 312 +/- 64 mg/dl, p < 0.01), plasma viscosity (1.38 +/- 0.23 vs. 1.31 +/- 0.16 mPas, p < 0.01), red blood cell aggregation (13.2 +/- 2.5 vs. 12.1 +/- 3.1 E, p < 0.05) and plasmin-activator-inhibitor (6.11 +/- 3.4 vs. 4.7 +/- 2.7 U/l, p < 0.05).

View Article: PubMed Central - HTML - PubMed

Affiliation: Medizinische Klinik und Poliklinik B, Klinik für Kardiologie, Pneumologie und Angiologie, Heinrich-Heine-Universität, Duesseldorf, Germany. thomas.jax@profil-research.de

ABSTRACT

Background: Thrombosis is regarded to be a key factor in the development of acute coronary syndromes in patients with coronary artery disease (CAD). We hypothesize, that hemostatic and rheological risk factors may be of major relevance for the incidence and the risk stratification of these patients.

Methods: In 243 patients with coronary artery disease and stable angina pectoris parameters of metabolism, hemostasis, blood rheology and endogenous fibrinolysis were assessed. Patients were prospectively followed for 2 years in respect to elective revascularizations and acute coronary syndromes.

Results: During follow-up 88 patients presented with cardiac events, 22 of those were admitted to the hospital because of acute events, 5 Patients were excluded due to non- cardiac death. Patients with clinical events were found to be more frequently diabetic and presented with a more progressed coronary atherosclerosis. Even though patients with diabetes mellitus demonstrated a comparable level of multivessel disease (71% vs. 70%) the rate of elective revascularization was higher (41% vs. 28%, p < 0.05). The results were also unfavorable for the incidence of acute cardiovascular events (18% vs. 8%, p < 0.01). In comparison to non-diabetic patients diabetics demonstrated significantly elevated levels of fibrinogen (352 +/- 76 vs. 312 +/- 64 mg/dl, p < 0.01), plasma viscosity (1.38 +/- 0.23 vs. 1.31 +/- 0.16 mPas, p < 0.01), red blood cell aggregation (13.2 +/- 2.5 vs. 12.1 +/- 3.1 E, p < 0.05) and plasmin-activator-inhibitor (6.11 +/- 3.4 vs. 4.7 +/- 2.7 U/l, p < 0.05).

Conclusion: Pathological alterations of fibrinogen, blood rheology and plasminogen-activator-inhibitor as indicators of a procoagulant state are of major relevance for the short-term incidence of cardiac events, especially in patients with diabetes mellitus type 2, and may be used to stratify patients to specific therapies.

Show MeSH
Related in: MedlinePlus