| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
From the Department of Cardiology (G.M., F.P., D.T.), the Laboratory of
Biochemistry (C.J., M.C., J.P.B.), and the Laboratory of Hemostasis (A.A.),
Pitié-Salpétrière Hospital, Paris; the Laboratory of
Biophysics (E.V.), Fernand Widal Hospital, Paris; the Department of Cardiology
(E.B.), Arras Hospital, Arras; the Department of Cardiology (J.E.P.),
Abbeville Hospital, Abbeville; the Department of Cardiology (D.C.), Purpan
Hospital, Toulouse; the Department of Cardiology (D.F.), Angoulème
Hospital, Angoulème; the Department of Cardiology (A.D.),
Saint-Philibert Hospital, Lomme; the Laboratory of Biochemistry (A.C.), C.H.U.
Pitié-Salpétrière, Paris; and Rhone-Poulenc-Rorer (F.B.),
Croix de Berny, France.
Correspondence to Gilles Montalescot, MD, PhD, Department of Cardiology, Centre Hospitalier Universitaire Pitié-Salpétrière, 47 boulevard de l'Hôpital, 75013, Paris, France. E-mail gilles.montalescot{at}psl.ap-hop-paris.fr
Background—The pathogenesis of
unstable angina and non–Q-wave myocardial infarction is still poorly
understood, and early evaluation of prognosis remains difficult. We
therefore studied the predictive value of 5 biological indicators of
inflammation, thrombogenesis, vasoconstriction, and myocardial
necrosis, and we examined the effects of enoxaparin and unfractionated
heparin on these markers after 48 hours of treatment.
Methods and Results—Sixty-eight patients with unstable angina or
non–Q-wave myocardial infarction randomized in the international
ESSENCE trial participated in this French substudy. C-reactive protein,
fibrinogen, von Willebrand factor antigen, endothelin-1 and
troponin I were measured on admission and 48 hours later. The composite
end point of death, myocardial infarction, recurrent angina, or
revascularization was significantly lower at 14 and
30 days of follow-up in patients allocated to enoxaparin compared with
unfractionated heparin. All acute-phase reactant proteins were elevated
on admission and increased further at 48 hours.
Multivariate analysis demonstrated that the
rise of von Willebrand factor over 48 hours was a significant
and independent predictor of the composite end point at both 14 days
and 30 days. Moreover the early increase of von Willebrand
factor was more frequent and more severe with unfractionated heparin
than with enoxaparin (mean change was +8.7±8.8% with enoxaparin
versus +93.9±11.7% with unfractionated heparin,
P<0.0001). The other clinical and biological
variables did not predict outcome.
Conclusions—In patients with unstable angina or non–Q-wave
myocardial infarction, the acute-phase proteins increase over the first
2 days despite medical treatment. The early rise of von
Willebrand factor is an independent predictor of adverse
clinical outcome at 14 days and at 30 days. Enoxaparin provides
protection as evidenced by the reduced release of von
Willebrand factor, which represents a favorable
prognostic finding.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Early Increase of von Willebrand Factor Predicts Adverse Outcome in Unstable Coronary Artery Disease
Beneficial Effects of Enoxaparin
Key Words: coronary disease • von Willebrand factor • C-reactive protein • fibrinogen • heparin
This article has been cited by other articles:
 |
|
 |
|
  K. Fattouch, R. Sampognaro, E. Navarra, M. Caruso, C. Pisano, G. Coppola, G. Speziale, and G. Ruvolo Long-term results after repair of type a acute aortic dissection according to false lumen patency. Ann. Thorac. Surg., October 1, 2009; 88(4): 1244 - 1250. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. P. Bonaca and D. A. Morrow Defining a Role for Novel Biomarkers in Acute Coronary Syndromes Clin. Chem., September 1, 2008; 54(9): 1424 - 1431. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. H. Cleator and D. E. Vaughan Clinical Implications of the Contrasting Effects of In Vivo Thrombin Receptor Activation (Protease-Activated Receptor Type 1) on the Human Vasculature J. Am. Coll. Cardiol., May 6, 2008; 51(18): 1757 - 1759. [Full Text] [PDF]
|
|
|
|
 |
|
 A. O. Spiel, J. C. Gilbert, and B. Jilma Von Willebrand Factor in Cardiovascular Disease: Focus on Acute Coronary Syndromes Circulation, March 18, 2008; 117(11): 1449 - 1459. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Dumaine, M. Borentain, O. Bertel, C. Bode, R. Gallo, H. D. White, J.-P. Collet, S. R. Steinhubl, and G. Montalescot Intravenous Low-Molecular-Weight Heparins Compared With Unfractionated Heparin in Percutaneous Coronary Intervention: Quantitative Review of Randomized Trials Arch Intern Med, December 10, 2007; 167(22): 2423 - 2430. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. C. Gilbert, T. DeFeo-Fraulini, R. M. Hutabarat, C. J. Horvath, P. G. Merlino, H. N. Marsh, J. M. Healy, S. BouFakhreddine, T. V. Holohan, and R. G. Schaub First-in-Human Evaluation of Anti von Willebrand Factor Therapeutic Aptamer ARC1779 in Healthy Volunteers Circulation, December 4, 2007; 116(23): 2678 - 2686. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Montalescot and on behalf of the OPERA investigators STEMI and NSTEMI are two distinct pathophysiological entities: reply Eur. Heart J., November 1, 2007; 28(21): 2685 - 2686. [Full Text] [PDF]
|
|
|
|
 |
|
 F. Bilora, E. Zanon, A. Casonato, A. Bertomoro, F. Petrobelli, M. Cavraro, E. Campagnolo, and A. Girolami Type IIB von Willebrand Disease: Role of Qualitative Defects in Atherosclerosis and Endothelial Dysfunction Clinical and Applied Thrombosis/Hemostasis, October 1, 2007; 13(4): 384 - 390. [Abstract] [PDF]
|
|
|
|
|
|
R. De Caterina, S. Husted, L. Wallentin, G. Agnelli, F. Bachmann, C. Baigent, J. Jespersen, S. D. Kristensen, G. Montalescot, A. Siegbahn, et al. Anticoagulants in heart disease: current status and perspectives Eur. Heart J., April 10, 2007; (2007) ehl492v1. [Full Text] [PDF]
|
|
|
|
|
|
M. Shiono, M. Hata, A. Sezai, T. Niino, S. Yagi, and N. Negishi Validity of a Limited Ascending and Hemiarch Replacement for Acute Type A Aortic Dissection Ann. Thorac. Surg., November 1, 2006; 82(5): 1665 - 1669. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Montalescot, H. D. White, R. Gallo, M. Cohen, P. G. Steg, P. E.G. Aylward, C. Bode, M. Chiariello, S. B. King III, R. A. Harrington, et al. Enoxaparin versus unfractionated heparin in elective percutaneous coronary intervention. N. Engl. J. Med., September 7, 2006; 355(10): 1006 - 1017. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. H. Cleator, W. Q. Zhu, D. E. Vaughan, and H. E. Hamm Differential regulation of endothelial exocytosis of P-selectin and von Willebrand factor by protease-activated receptors and cAMP Blood, April 1, 2006; 107(7): 2736 - 2744. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. J. Armstrong, D. A. Morrow, and M. S. Sabatine Inflammatory Biomarkers in Acute Coronary Syndromes: Part II: Acute-Phase Reactants and Biomarkers of Endothelial Cell Activation Circulation, February 21, 2006; 113(7): e152 - e155. [Full Text] [PDF]
|
|
|
|
|
|
M. S. Sabatine, D. A. Morrow, G. Montalescot, M. Dellborg, J. L. Leiva-Pons, M. Keltai, S. A. Murphy, C. H. McCabe, C. M. Gibson, C. P. Cannon, et al. Angiographic and Clinical Outcomes in Patients Receiving Low-Molecular-Weight Heparin Versus Unfractionated Heparin in ST-Elevation Myocardial Infarction Treated With Fibrinolytics in the CLARITY-TIMI 28 Trial Circulation, December 20, 2005; 112(25): 3846 - 3854. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. J. Teede, F. S. Dalais, D. Kotsopoulos, B. P. McGrath, E. Malan, T. E. Gan, and R. E. Peverill Dietary Soy Containing Phytoestrogens Does Not Activate the Hemostatic System in Postmenopausal Women J. Clin. Endocrinol. Metab., April 1, 2005; 90(4): 1936 - 1941. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. K. Ray, D. A. Morrow, C. M. Gibson, S. Murphy, E. M. Antman, E. Braunwald, and for the ENTIRE-TIMI 23 Study Group Predictors of the rise in vWF after ST elevation myocardial infarction: implications for treatment strategies and clinical outcome: An ENTIRE-TIMI 23 substudy Eur. Heart J., March 1, 2005; 26(5): 440 - 446. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. W. Lee, G. Y. H. Lip, M. Tayebjee, W. Foster, and A. D. Blann Circulating endothelial cells, von Willebrand factor, interleukin-6, and prognosis in patients with acute coronary syndromes Blood, January 15, 2005; 105(2): 526 - 532. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Chiappini, M. Schepens, E. Tan, A. D. Amore, W. Morshuis, K. Dossche, M. Bergonzini, N. Camurri, L. B. Reggiani, G. Marinelli, et al. Early and late outcomes of acute type A aortic dissection: analysis of risk factors in 487 consecutive patients Eur. Heart J., January 2, 2005; 26(2): 180 - 186. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Montalescot, J.P. Collet, M.L. Tanguy, A. Ankri, L. Payot, R. Dumaine, R. Choussat, F. Beygui, V. Gallois, and D. Thomas Anti-Xa Activity Relates to Survival and Efficacy in Unselected Acute Coronary Syndrome Patients Treated With Enoxaparin Circulation, July 27, 2004; 110(4): 392 - 398. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Matsuda, A. Marumoto, H. Nakashima, Y. Nakamura, S. Kamihira, S. Ishiguro, and S. Ohgi Congenital pericardial defect associated with ruptured type a aortic dissection Ann. Thorac. Surg., March 1, 2004; 77(3): 1069 - 1070. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.P. Collet, G. Montalescot, E. Vicaut, A. Ankri, F. Walylo, C. Lesty, R. Choussat, F. Beygui, M. Borentain, N. Vignolles, et al. Acute Release of Plasminogen Activator Inhibitor-1 in ST-Segment Elevation Myocardial Infarction Predicts Mortality Circulation, July 29, 2003; 108(4): 391 - 394. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A.-Y. Chong, A.D. Blann, and G.Y.H. Lip Assessment of endothelial damage and dysfunction: observations in relation to heart failure QJM, April 1, 2003; 96(4): 253 - 267. [Full Text] [PDF]
|
|
|
|
|
|
E. J. Topol A guide to therapeutic decision-making in patients with non-ST-segment elevation acute coronary syndromes J. Am. Coll. Cardiol., February 19, 2003; 41(4_Suppl_S): 123S - 129S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. C. Wong, R. P. Giugliano, and E. M. Antman Use of Low-Molecular-Weight Heparins in the Management of Acute Coronary Artery Syndromes and Percutaneous Coronary Intervention JAMA, January 15, 2003; 289(3): 331 - 342. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R.e. Choussat, G. Montalescot, J. P. Collet, E. Vicaut, A. Ankri, V. Gallois, G.e. Drobinski, I. Sotirov, and D. Thomas A unique, low dose of intravenous enoxaparin in elective percutaneous coronary intervention J. Am. Coll. Cardiol., December 4, 2002; 40(11): 1943 - 1950. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. E. Rabbani, N. A. Seminario, R. R. Sciacca, H. J. Chen, and E.-G. V. Giardina Oral conjugated equine estrogen increases plasma von Willebrand factor in postmenopausal women J. Am. Coll. Cardiol., December 4, 2002; 40(11): 1991 - 1999. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.W. Eikelboom, J.I. Weitz, A. Budaj, F. Zhao, I. Copland, P. Maciejewski, M. Johnston, and S. Yusuf Clopidogrel does not suppress blood markers of coagulation activation in aspirin-treated patients with non-ST-elevation acute coronary syndromes Eur. Heart J., November 2, 2002; 23(22): 1771 - 1779. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. P. Ehrlich, M. Grabenwoger, J. Kilo, A. A. Kocher, G. Grubhofer, A. M. Lassnig, E. M. Tschernko, B. Schlechta, D. Hutschala, H. Domanovits, et al. Surgical treatment of acute type a dissection: is rupture a risk factor? Ann. Thorac. Surg., June 1, 2002; 73(6): 1843 - 1848. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Bachet Acute type A aortic dissection: can we dramatically reduce the surgical mortality? Ann. Thorac. Surg., March 1, 2002; 73(3): 701 - 703. [Full Text] [PDF]
|
|
|
|
|
|
E.M. Antman, M. Cohen, C. McCabe, S.G. Goodman, S.A. Murphy, and E. Braunwald Enoxaparin is superior to unfractionated heparin for preventing clinical events at 1-year follow-up of TIMI 11B and ESSENCE Eur. Heart J., February 2, 2002; 23(4): 308 - 314. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. D. White and C. K. Wong Risk stratification and treatment benefits in patients with non-ST-elevation acute coronary syndromes Eur. Heart J., February 1, 2002; 23(3): 187 - 191. [Full Text] [PDF]
|
|
|
|
 |
|
 K. Bayegan, H. Domanovits, M. Schillinger, M. Ehrlich, G. Sodeck, and A.N. Laggner Acute type A aortic dissection: the prognostic impact of preoperative cardiac tamponade Eur. J. Cardiothorac. Surg., December 1, 2001; 20(6): 1194 - 1198. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. H. Solomon, P. H. Stone, R. J. Glynn, D. A. Ganz, C. M. Gibson, R. Tracy, and J. Avorn Use of risk stratification to identify patients with unstable angina likeliest to benefit from an invasive versus conservative management strategy J. Am. Coll. Cardiol., October 1, 2001; 38(4): 969 - 976. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. A. Elhadd, T. A. Abdu, J. Oxtoby, G. Kennedy, M. McLaren, R. Neary, J. J. F. Belch, and R. N. Clayton Biochemical and Biophysical Markers of Endothelial Dysfunction in Adults with Hypopituitarism and Severe GH Deficiency J. Clin. Endocrinol. Metab., September 1, 2001; 86(9): 4223 - 4232. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. G. G. Turpie and E. M. Antman Low-Molecular-Weight Heparins in the Treatment of Acute Coronary Syndromes Arch Intern Med, June 25, 2001; 161(12): 1484 - 1490. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. L. Reich, S. Uysal, M. A. Ergin, C. A. Bodian, S. Hossain, and R. B. Griepp Retrograde cerebral perfusion during thoracic aortic surgery and late neuropsychological dysfunction Eur. J. Cardiothorac. Surg., May 1, 2001; 19(5): 594 - 600. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Kawahito, H. Adachi, A. Yamaguchi, and T. Ino Preoperative risk factors for hospital mortality in acute type A aortic dissection Ann. Thorac. Surg., April 1, 2001; 71(4): 1239 - 1243. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Ph. Collet, G. Montalescot, L. Lison, R. Choussat, A. Ankri, G. Drobinski, I. Sotirov, and D. Thomas Percutaneous Coronary Intervention After Subcutaneous Enoxaparin Pretreatment in Patients With Unstable Angina Pectoris Circulation, February 6, 2001; 103(5): 658 - 663. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Figueras, Y. Monasterio, R. M. Lidon, E. Nieto, and J. Soler-Soler Thrombin formation and fibrinolytic activity in patients with acute myocardial infarction or unstable angina: in-hospital course and relationship with recurrent angina at rest J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2036 - 2043. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. G. Goodman, A. Barr, A. Sobtchouk, M. Cohen, G. J. Fromell, L. Laperriere, C. Hill, A. Langer, and for the Canadian Efficacy and Safety of Subcutaneo Low molecular weight heparin decreases rebound ischemia in unstable angina or non-Q-wave myocardial infarction: the Canadian ESSENCE ST segment monitoring substudy J. Am. Coll. Cardiol., November 1, 2000; 36(5): 1507 - 1513. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Kaul and P. K. Shah Low molecular weight heparin in acute coronary syndrome: evidence for superior or equivalent efficacy compared with unfractionated heparin? J. Am. Coll. Cardiol., June 1, 2000; 35(7): 1699 - 1712. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Jager, V. W. M. van Hinsbergh, P. J. Kostense, J. J. Emeis, J. S. Yudkin, G. Nijpels, J. M. Dekker, R. J. Heine, L. M. Bouter, and C. D. A. Stehouwer von Willebrand Factor, C-Reactive Protein, and 5-Year Mortality in Diabetic and Nondiabetic Subjects : The Hoorn Study Arterioscler Thromb Vasc Biol, December 1, 1999; 19(12): 3071 - 3078. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. R. Ferreiros, C. P. Boissonnet, R. Pizarro, P. F. G. Merletti, G. Corrado, A. Cagide, and O. O. Bazzino Independent Prognostic Value of Elevated C-Reactive Protein in Unstable Angina Circulation, November 9, 1999; 100(19): 1958 - 1963. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Purcell and K.M. Fox Improving outcome in acute coronary syndromes -- as good as it gets? Eur. Heart J., November 1, 1999; 20(21): 1533 - 1537. [PDF]
|
|
|
|
|
|
E. M. Antman, M. Cohen, D. Radley, C. McCabe, J. Rush, J. Premmereur, and E. Braunwald Assessment of the Treatment Effect of Enoxaparin for Unstable Angina/Non-Q-Wave Myocardial Infarction : TIMI 11B-ESSENCE Meta-Analysis Circulation, October 12, 1999; 100(15): 1602 - 1608. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. R. Y. De Meyer, M. F. Hoylaerts, M. M. Kockx, H. Yamamoto, A. G. Herman, and H. Bult Intimal Deposition of Functional von Willebrand Factor in Atherogenesis Arterioscler Thromb Vasc Biol, October 1, 1999; 19(10): 2524 - 2534. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. J. Siegel, M. B. Sholar, J. H. Mendelson, S. E. Lukas, M. J. Kaufman, P. F. Renshaw, J. C. McDonald, K. B. Lewandrowski, F. S. Apple, J. J. Stec, et al. Cocaine-Induced Erythrocytosis and Increase in von Willebrand Factor: Evidence for Drug-Related Blood Doping and Prothrombotic Effects Arch Intern Med, September 13, 1999; 159(16): 1925 - 1929. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Keightley, Y. M. Lam, J. N. Brady, C. L. Cameron, and D. Lillicrap Variation at the von Willebrand Factor (vWF) Gene Locus Is Associated With Plasma vWF:Ag Levels: Identification of Three Novel Single Nucleotide Polymorphisms in the vWF Gene Promoter Blood, June 15, 1999; 93(12): 4277 - 4283. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Aguilar and S. Z. Goldhaber Clinical Uses of Low-Molecular-Weight Heparins Chest, May 1, 1999; 115(5): 1418 - 1423. [Full Text] [PDF]
|
|
|
|
|
|
T. O. Cheng Unexplained Acronyms Circulation, April 13, 1999; 99 (14): 1922 - 1926. [Full Text] [PDF]
|
|
|
|
|
|
E. M. Antman and R. Handin Low-Molecular-Weight Heparins : An Intriguing New Twist With Profound Implications Circulation, July 28, 1998; 98(4): 287 - 289. [Full Text] [PDF]
|
|