Association of recurrent myocardial infarction with hemostatic factors: a prospective study.

In a perspective blind study of 147 survivors of myocardial infarction, the 13 patients who had definite recurrent infarction during 38.1 +/- 7.2 months (minimum, 34 months) of follow-up had higher plasma fibrinogen levels (334.4 +/- 13.1 mg/dl vs 291.5 +/- 4.7 mg/dl; P = 0.0055), and higher maximum rate of fibrin growth (generation of turbidity) when measuring prothrombin time (PT Vmax, 7.76 +/- 0.31 units vs 6.48 +/- 0.11 units; P = 0.0003), thrombin time (TT Vmax, 5.24 +/- 0.32 units vs 4.22 +/- 0.11 units; P = 0.0002), and activated partial thromboplastin time (APTT Vmax, 7.47 +/- 0.29 units vs 6.20 +/- 0.10 units; P = 0.0001) than patients who did not have reinfarction. Eleven of the 13 reinfarctions occurred among the quartile (37 patients) with the highest PT Vmax, while only two reinfarctions occurred among the remaining 110 patients (risk ratio, 16.5). The quartile with highest APTT Vmax included nine reinfarctions (risk ratio, 6.7), and the quartiles with the most fibrinogen and largest TT Vmax included eight of the 13 reinfarctions (risk ratio, 4.8). Significant associations (P = 0.018 to 0.005, risk ratios, 2.5 to 4.8) of reinfarction with the values of Vmax corrected for fibrinogen were also found. These findings support recent evidence that hemostatic function contributes to the pathogenesis of the complications of coronary artery disease.