Publication Date:
2014-12-06
Description:
Major coronary events are commonly precipitated by thrombotic occlusion of atheromatous vessels. We determined whether d-dimer, C-reactive protein (CRP), or serum amyloid A (SAA), increase in the months prior to an acute coronary events in patients with severe lower extremity peripheral artery disease (PAD). The Biomarker Risk Assessment in Vulnerable Outpatients (BRAVO) Study enrolled patients with PAD and followed them prospectively every two months. At each visit, participants were queried about new hospitalizations, blood was obtained, electrocardiograms performed, and mortality data collected. Two controls for each patient with events were randomly selected from participants without events, matched for age, sex, race, duration in the study, and number of blood draws. D-dimer was measured using an immunoturbidometric assay (Asserachrom D-Di kit, Diagnostica Stago, Parsippany, NJ). CRP and SAA were determined using an immunotechnique on the Behring BN II analyzer (Dade Behring, Wilmington, DE). Changes in levels of these biomarkers during the months leading up to the primary outcome (acute MI, new MI detected by ECG, hospitalization for unstable angina, cardiac death) were the independent variables of interest. A total of 595 participants with PAD were followed for a mean of 1.56 years; 50 (8.4%) experienced 75 acute coronary events. Sixteen of these cases had five complete visits immediately prior to the event, allowing a comparison of D-dimer levels over time within the same cohort of study participants. Their median/interquartile D-dimer (mg/L, log-transformed) just prior to the event was 1.05 (0.62-1.62); the level was significantly lower at each of the other 4 visits (0.69, 0.71, 0.83, 0.86; all P
Print ISSN:
0006-4971
Electronic ISSN:
1528-0020
Topics:
Biology
,
Medicine
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