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Platelet activation, thrombin generation and fibrin formation play important roles in intracoronary thrombus formation, which may lead to acute myocardial infarction.  We investigated whether the prothrombotic markers D-dimer, pro-thrombin fragment 1 + 2 (F1 + 2) and endogenous thrombin potential (ETP) are associated with myocardial necrosis assessed by Troponin T (TnT), and left ventricular impairment assessed by left ventricular ejection fraction (LVEF) and N-terminal pro b-type natriuretic peptide (NT-proBNP).    Materials/Methods  Patients ( n  = 987) with ST-elevation mycardial infarction (STEMI) were included. Blood samples were drawn at a median time of 24 h after onset of symptoms.    Results  Statistically significant correlations were found between both peak TnT and D-dimer ( p  < 0.001) and F1 + 2 ( p  < 0.001), and between NT-proBNP and D-dimer ( p  = 0.001) and F1 + 2 ( p  < 0.001). When dividing TnT and NT-proBNP levels into quartiles there were significant trends for increased levels of both markers across quartiles (all  p  < 0.001) D-dimer remained significantly associated with NT-proBNP after adjustments for covariates ( p  = 0.001) whereas the association between NTproBNP and F1 + 2 was no longer statistically significant ( p  = 0.324).  A significant inverse correlation was found between LVEF and D-dimer ( p  < 0.001) and F1 + 2 ( p  = 0.013). When dichotomizing LVEF levels at 40 %, we observed significantly higher levels of both D-dimer ( p  < 0.001) and F1 + 2 ( p  = 0.016) in the group with low EF ( n  = 147).    Summary/conclusion  In our cohort of STEMI patients we demonstrated that levels of D-dimer and F1 + 2 were significantly associated with myocardial necrosis as assessed by peak TnT. High levels of these coagulation markers in patients with low LVEF and high NTproBNP may indicate a hypercoagulable state in patients with impaired myocardial function.

thrombosis journal

Markers of thrombin generation are associated with myocardial necrosis and left ventricular impairment in patients with ST-elevation myocardial infarction