COAGULOGIC FACTORS RELATED TO DEVELOPMENT OF MYOCARDIAL REINFARCTION

To elucidate relation of some coagulogic parameters to development of myocardial reinfarction (RI) we studied 163 patients (153 men) aged 30-76 years (mean age 52, 3+/-0, 7 years) admitted to coronary care unit within first 6 hours of myocardial infarction (MI) (mean time after onset of attack - 3, 1+/-0, 1 hours). During hospitalization 10 (6%) of these patients (pts) had RI (3 fatal) and 14 pts died of other causes. After discharge 146 pts were followed for 17+/-2 months. During follow-up RI (late RI) developed in 15 (10%) pts (2 RI's were fatal). Pts with inhospital RI.s differed from other pts by alpha2-antiplasmin level at 3 hours after onset of thrombolytic therapy (OTT) (6.8+/-2.6 vs 23.9+/-3.2%, p=0.046). Pts with late RI.s compared to other pts had lower protein C at 36 hours after OTT (76.1+/-13.1 vs 110.1+/-4.5%, p=0.04), higher plasminogen activator inhibitor at 48 hours after OTT (26.8+/-6.8 vs 13.4+/-1.4 IE/ml, p=0.04), longer thrombin time at 24 and 48 hours after OTT (median >250 sec vs 38.5 sec, p=0.005, and >250 sec vs 21.5 sec, p=0.002, respectively), longer activated partial thrombplastin time at 24 and 48 hours after OTT (median 117 vs 45.9 sec, p=0.02, and 237 vs 38.8 sec, p=0.03, respectively) and lower fibrinogen on day 7 of initial MI (3.9+/-0.3 vs 4.5+/-0.1 g/I, p=0.07). At multifactorial analysis with the use of Cox model the following combination of parameters was related to development of late RI: thrombin time exceeding 27 sec at 24 hours, partial thromboplastin time over 75 sec at 48 hours after OTT and fibrinogen level below 3.0 g/I on day 7 of initial MI.