Retterstol L, Kierulf P, Pedersen J C, Bohn M, Bakken A, Erikssen J, Berg K
Institute of Medical Genetics, University of Oslo, Norway.
J Intern Med. 2001 Jun;249(6):511-8. doi: 10.1046/j.1365-2796.2001.00837.x.
To investigate the prognostic value of plasma fibrinogen level amongst middle-aged survivors of myocardial infarction (MI).
Prospective cohort study.
Determination of fibrinogen and other prognostic variables in MI patients recruited in a presumably stable phase of coronary heart disease (CHD).
A total of 247 middle-aged CHD patients (54 women and 193 men) who had their first MI at age < or = 60 (women) or < or = 55 (men) were recruited at least 3 months after (mean 2.1 years) the most recent MI.
The primary endpoint was total mortality, and the secondary endpoint was cardiac deaths. The tertiary endpoint was major cardiac events (cardiac death, MI and cardiac arrest).
During a follow-up period of 10 years a total of 44 patients had died, 36 from cardiac causes. Major cardiac event occurred in 70 patients. After adjusting for age, ejection fraction (EF), total serum cholesterol (TC), smoking and hypertension, patients in the top quartile of fibrinogen (> or = 4.0 g L-1) had a relative risk (RR) of 1.8 (95% CI 1.0-3.6) (P = 0.07) for death of all causes. The top quartile of fibrinogen was a stronger predictor of cardiac death; RR = 2.2 (95% CI 1.1-4.4) (P = 0.03), whilst the effect on the endpoint major cardiac event was not significant; RR=1.1 (95% CI 0.6-1.9) (P = 0.69).
A plasma fibrinogen level in the top quartile predicted cardiac death in middle-aged patients who had suffered MI.
探讨血浆纤维蛋白原水平在心肌梗死（MI）中年幸存者中的预后价值。
前瞻性队列研究。
在冠心病（CHD）可能处于稳定期时招募MI患者，测定其纤维蛋白原及其他预后变量。
共招募了247例中年CHD患者（54例女性和193例男性），他们在年龄≤60岁（女性）或≤55岁（男性）时首次发生MI，且在最近一次MI至少3个月后（平均2.1年）入组。
主要终点为全因死亡率，次要终点为心源性死亡。三级终点为主要心脏事件（心源性死亡、MI和心脏骤停）。
在10年的随访期内，共有44例患者死亡，其中36例死于心脏原因。70例患者发生了主要心脏事件。在调整年龄、射血分数（EF）、总血清胆固醇（TC）、吸烟和高血压后，纤维蛋白原处于最高四分位数（≥4.0 g/L）的患者全因死亡的相对风险（RR）为1.8（95%CI 1.0 - 3.6）（P = 0.07）。纤维蛋白原最高四分位数是心源性死亡更强的预测指标；RR = 2.2（95%CI 1.1 - 4.4）（P = 0.03），而对终点主要心脏事件的影响不显著；RR = 1.1（95%CI 0.6 - 1.9）（P = 0.69）。
纤维蛋白原处于最高四分位数可预测MI中年患者的心源性死亡。
