Fibrin clot properties independently predict adverse clinical outcome following acute coronary syndrome: a PLATO substudy
Authors' conclusion
Fibrin clots that are resistant to lysis independently predict adverse outcome in ACS patients.
Study context
- Population
- Acute coronary syndrome (ACS) patients randomised to clopidogrel or ticagrelor in PLATO, plasma sampled at hospital discharge
- Participants
- 4,354 patients
- Comparison
- Fibrin clot properties and 1-year outcomes
- Primary endpoint
- CV death, spontaneous myocardial infarction (MI) and PLATO-defined major bleeding
- Follow-up
- 1 year after sample collection
Primary result
As reported in the abstract
Association per 50% increase in clot property (adjusted for CV risk factors) · 1 year
Hazard ratio (95% CI)P value
Lysis time (per 50% increase)CV death/spontaneous MI
1.17(1.05–1.31)
P < 0.01Lysis time (per 50% increase)CV death
1.36(1.17–1.59)
P < 0.001Maximum turbidity (per 50% increase)CV death
1.24(1.03–1.50)
P = 0.024Per 50% increase, as printed
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| CV death, after adjustment for other prognostic biomarkers · 1 yearPer 50% increase in lysis time | 1.2 (1.01–1.42) | P = 0.042 | |
| 0.512Hazard ratio (log scale) |
- Cardiovascular (CV) death, after adjustment for other prognostic biomarkers: adjusted for leukocyte count, hs-CRP, hs-troponin T, cystatin C, NT-proBNP and GDF-15
CV death, after adjustment for other prognostic biomarkers · 1 year
- Association with CV death not significant for maximum turbidity after biomarker adjustment
Consistency by randomised antiplatelet treatment
- Associations consistent regardless of randomised antiplatelet treatment
- all interaction P > 0.05
Safety
PLATO-defined major bleeding
- Neither lysis time nor maximum turbidity associated with major bleeding
Original publication
Fibrin clot properties independently predict adverse clinical outcome following acute coronary syndrome: a PLATO substudy. Eur Heart J. Published 29 January 2018. doi:10.
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