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(Circulation. 1997;96:4204-4210.)
© 1997 American Heart Association, Inc.
Articles |
Prognostic Influence of Increased Fibrinogen and C-Reactive Protein Levels in Unstable Coronary Artery Disease
From the Department of Cardiology (H.T., B.L., L.W.) and Laboratory for Coagulation Research (A.S.), Department of Clinical Laboratory Sciences, University Hospital, Uppsala, Sweden.
Correspondence to Dr Henrik Toss, Department of Cardiology, University Hospital, S-751 85 Uppsala, Sweden.
Background The prognostic influences of fibrinogen and C-reactive protein levels and their relations to myocardial damage in unstable coronary artery syndromes have not been well described.
Methods and Results Fibrinogen and C-reactive protein were
determined at inclusion and related to outcome after 5 months in 965
patients with unstable angina or non–Q-wave myocardial infarction
randomized to 5 weeks with low-molecular-weight heparin or placebo. The
probabilities of death were 1.6%, 4.6%, and 6.9%
(P=.005) and the probabilities of death and/or
myocardial infarction were 9.3%, 14.2%, and 19.1%
(P=.002), respectively, in patients stratified by
tertiles of fibrinogen (<3.38, 3.38 to 3.99, and 
4.0 g/L). The
probabilities of death were 2.2%, 3.6%, and 7.5%
(P=.003) after stratification of patient data by
tertiles of C-reactive protein level (<2, 2 to 10, and >10 mg/L). In
logistic multiple regression analysis, increased fibrinogen
levels were independently associated with the incidence of death and/or
myocardial infarction (P=.013), and elevated C-reactive
protein level was associated with the incidence of death
(P=.012). The increased relative risk of subsequent
death or myocardial infarction in individuals with an elevated
fibrinogen level was consistent in most subgroups evaluated;
although significantly so only in patients with signs of myocardial
damage.
Conclusions Increased levels of both fibrinogen and C-reactive protein are associated with a worse outcome in patients with unstable coronary artery disease. The increased risk associated with elevated fibrinogen levels is independent of, and additive to, the prognostic influence of myocardial damage.
Key Words: angina • fibrinogen • mycardial infarction • prognosis • risk factors
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C. Heeschen, C. W. Hamm, J. Bruemmer, M. L. Simoons, and for the CAPTURE Investigators Predictive value of C-reactive protein and troponin T in patients with unstable angina: a comparative analysis J. Am. Coll. Cardiol., May 1, 2000; 35(6): 1535 - 1542. [Abstract] [Full Text] [PDF]
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A. Nakagomi, S. B. Freedman, and C. L. Geczy Interferon-{gamma} and Lipopolysaccharide Potentiate Monocyte Tissue Factor Induction by C-Reactive Protein : Relationship With Age, Sex, and Hormone Replacement Treatment Circulation, April 18, 2000; 101(15): 1785 - 1791. [Abstract] [Full Text] [PDF]
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E. S. Ford and W. H. Giles Serum C-Reactive Protein and Self-Reported Stroke : Findings From the Third National Health and Nutrition Examination Survey Arterioscler Thromb Vasc Biol, April 1, 2000; 20(4): 1052 - 1056. [Abstract] [Full Text] [PDF]
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Y Zhu, Y Hojo, U Ikeda, K Shimada;, and G F BAXTER Production of hepatocyte growth factor during acute myocardial infarction Heart, April 1, 2000; 83(4): 450 - 455. [Abstract] [Full Text]
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P. M. Ridker, C. H. Hennekens, J. E. Buring, and N. Rifai C-Reactive Protein and Other Markers of Inflammation in the Prediction of Cardiovascular Disease in Women N. Engl. J. Med., March 23, 2000; 342(12): 836 - 843. [Abstract] [Full Text] [PDF]
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D. A. Morrow, N. Rifai, E. M. Antman, D. L. Weiner, C. H. McCabe, C. P. Cannon, and E. Braunwald Serum amyloid A predicts early mortality in acute coronary syndromes: a TIMI 11A substudy J. Am. Coll. Cardiol., February 1, 2000; 35(2): 358 - 362. [Abstract] [Full Text] [PDF]
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B. W. Walsh, S. Paul, R. A. Wild, R. A. Dean, R. P. Tracy, D. A. Cox, and P. W. Anderson The Effects of Hormone Replacement Therapy and Raloxifene on C-Reactive Protein and Homocysteine in Healthy Postmenopausal Women: A Randomized, Controlled Trial J. Clin. Endocrinol. Metab., January 1, 2000; 85(1): 214 - 218. [Abstract] [Full Text]
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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]
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 K. J. Harjai Potential New Cardiovascular Risk Factors: Left Ventricular Hypertrophy, Homocysteine, Lipoprotein(a), Triglycerides, Oxidative Stress, and Fibrinogen Ann Intern Med, September 7, 1999; 131(5): 376 - 386. [Abstract] [Full Text] [PDF]
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W. K. Lagrand, C. A. Visser, W. T. Hermens, H. W. M. Niessen, F. W. A. Verheugt, G.-J. Wolbink, and C. E. Hack C-Reactive Protein as a Cardiovascular Risk Factor : More Than an Epiphenomenon? Circulation, July 6, 1999; 100(1): 96 - 102. [Abstract] [Full Text] [PDF]
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 J. F. KEANEY JR., D. I. SIMON, and J. E. FREEDMAN Vitamin E and vascular homeostasis: implications for atherosclerosis FASEB J, June 1, 1999; 13(9): 965 - 975. [Abstract] [Full Text]
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G. Maresca, A. Di Blasio, R. Marchioli, and G. Di Minno Measuring Plasma Fibrinogen to Predict Stroke and Myocardial Infarction : An Update Arterioscler Thromb Vasc Biol, June 1, 1999; 19(6): 1368 - 1377. [Abstract] [Full Text] [PDF]
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M. H. Moghadasian, B. M. McManus, D. V. Godin, B. Rodrigues, and J. J. Frohlich Proatherogenic and Antiatherogenic Effects of Probucol and Phytosterols in Apolipoprotein E–Deficient Mice : Possible Mechanisms of Action Circulation, April 6, 1999; 99(13): 1733 - 1739. [Abstract] [Full Text] [PDF]
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P. W. H. M. Verheggen, M. P. M. de Maat, V. M. Cats, F. Haverkate, A. H. Zwinderman, C. Kluft, and A. V. G. Bruschke Inflammatory status as a main determinant of outcome in patients with unstable angina, independent of coagulation activation and endothelial cell function Eur. Heart J., April 2, 1999; 20(8): 567 - 574. [Abstract] [PDF]
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R. J de Winter, R. Bholasingh, J. G Lijmer, R. W Koster, J. P.M.C Gorgels, Y. Schouten, F. J Hoek, and G. T Sanders Independent prognostic value of C-reactive protein and troponin I in patients with unstable angina or non-Q-wave myocardial infarction Cardiovasc Res, April 1, 1999; 42(1): 240 - 245. [Abstract] [Full Text] [PDF]
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R. Rabbani and E. J. Topol Strategies to achieve coronary arterial plaque stabilization Cardiovasc Res, February 1, 1999; 41(2): 402 - 417. [Abstract] [Full Text] [PDF]
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R. Ross Atherosclerosis -- An Inflammatory Disease N. Engl. J. Med., January 14, 1999; 340(2): 115 - 126. [Full Text] [PDF]
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G. Montalescot, F. Philippe, A. Ankri, E. Vicaut, E. Bearez, J. E. Poulard, D. Carrie, D. Flammang, A. Dutoit, A. Carayon, et al. Early Increase of von Willebrand Factor Predicts Adverse Outcome in Unstable Coronary Artery Disease : Beneficial Effects of Enoxaparin Circulation, July 28, 1998; 98(4): 294 - 299. [Abstract] [Full Text] [PDF]
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J. Danesh, R. Collins, P. Appleby, and R. Peto Association of Fibrinogen, C-reactive Protein, Albumin, or Leukocyte Count With Coronary Heart Disease: Meta-analyses of Prospective Studies JAMA, May 13, 1998; 279(18): 1477 - 1482. [Abstract] [Full Text] [PDF]
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