Thrombosis and endogenous fibrinolysis in the deferred period of myocardial infarction

Authors: Kalinskaya A.I, Dukhin O.A., Uzhakhova Kh.M., Vasilieva E.Yu., Shpektor A.V.

Company: Department of Cardiology of Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Moscow, 127473, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2020-14-1-24-34

For citation: Kalinskaya A.I., Dukhin O.A., Uzhakhova Kh.M., Vasilieva E.Yu., Shpektor A.V. Thrombosis and endogenous fibrinolysis in the deferred period of myocardial infarction. Creative Cardiology. 2020; 14 (1): 24–34 (in Russ.). DOI: 10.24022/1997-3187-2020-14-1-24-34

Received / Accepted:  05.03.2020 / 14.03.2020

Keywords: endogenous fibrinolysis myocardial infarction thrombosis spontaneous reperfusion

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Abstract

Objective: to evaluate the processes of thrombosis and endogenous fibrinolysis in patients with a history of ST-segment elevation myocardial infarction (STEMI).
Material and methods. 102 participants were included in the study: 51 patients (19 with spontaneous reperfusion (SR) of infarct-related artery (IRA) during coronary angiography, 32 with total occlusion) and 51 healthy volunteers. The parameters of hemostasis were evaluated using rotational thromboelastometry and thrombodynamics, endothelial function – using the flow-mediated dilation test (FMD) test, all patients underwent echocardiography.
Results. Patients with a history of STEMI are characterized by faster clot formation (CT, with 720 [625; 850] s vs 810 [699; 940] s, p = 0.01), larger clot size at various stages of the experiment (angle α 49 [46; 59]° vs 44 [39; 55], p < 0.01; A10, mm (41 [39; 49] vs 36 [33; 42], p < 0.01); A20 (52 [50; 57] mm vs 50 [44; 53], p = 0.01), earlier onset of clot lysis (LOT (38.0 [30.8; 53.7] min vs 65.3 [42.9; 79.3], p < 0.01) compared to healthy volunteers. Patients with a history of IRA occlusion had a faster clot growth rate (V (28.1 [26.3; 35.0] μm/min vs 31.9 [30.2; 38.8], p < 0.01), a larger clot size (CS 1190.5 [1160; 1292] μm vs 1315 [1204; 1458], p < 0.01), reduced flow-mediated
dilation test (FMD test 11.6 [8.4; 13.1]% vs 17.3 [14.4; 20.0], p < 0.01) and ejection fraction of the left ventricle (EF, % 55 [52; 60]% vs 62.0 [57.5; 64.0], p < 0.01) compared to patients with SR of IRA during coronary angiography.
Conclusion. Patients with myocardial infarction are characterized by increased activation of clotting and endogenous fibrinolysis compared with healthy volunteers. Among patients with IRA occlusion the clotting remains increased to a greater extent in comparison to patients with a history of SR of IRA.

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About Authors

  • Anna I. Kalinskaya, Associate Professor, Cand. Med. Sc., ORCID
  • Oleg A. Dukhin, Resident Physician,ORCID
  • Khyadi M. Uzhakhova, Postgraduate, ORCID
  • Aleksander V. Shpektor, Dr. Med. Sc., Professor, Corresponding Member of the Russian Academy of Sciences, Chief of Chair, Head of the University Clinic of Cardiology, ORCID
  • Elena Yu. Vasilieva, Dr. Med. Sc., Professor, Head of Atherothrombosis Laboratory, ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery