The prognostic value of plasma fi brinogen concentrations of patients with ST-elevation myocardial infarction and treated by primary percutaneous coronary intervention : A cautionary message

Background. Fibrinogen elevation is associated with a worse prognosis in patients with acute coronary syndrome (ACS). The aim of the present study was to assess the prognostic value of increased fi brinogen concentrations in ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI). Methods. A total of 428 STEMI patients treated with primary PCI were retrospectively selected (median age: 62 years; 82.5% males) from a continuous case series of 832 ACS patients. Plasma fi brinogen concentrations were measured before PCI and after 24, 48, and 72 hours. In the 4-year follow-up, one major adverse cardiovascular event (MACE) occurred in 111 patients (40%): 17 re-STEMI (7%), 64 re-PCI (22%), 22 cardiac deaths (7%), and eight non ST-elevated acute coronary syndromes (NSTEACS, 4%). Results. According to the reference change value, fi brinogen concentrations increased in 25% of patients at 24 h, 64% at 48 h and 19% at 72 h. Only fi brinogen concentrations at 48 h showed a mild association with overall MACEs ( p 0.036): the risk increased, starting from a concentration of 4 g/L. However a further multivariate model did not confi rm any prognostic value. No association with specifi c MACEs emerged. Conclusions. In contrast to NSTEACS patients, fi brinogen concentrations increased slightly in STEMI patients after primary PCI, however, they were not as prognostic as for MACEs.