Fibrin and Fibrinogen-Related Antigens in Patients with Stable and Unstable Coronary Artery Disease

Coronary-artery thrombosis may be important in the pathogenesis of unstable angina at rest. To study this possibility, we measured the serum concentrations of fibrin-related antigen, D dimer (the principal breakdown fragment of fibrin), and fibrin monomer (an intermediate product of fibrin formation) in the serum of five groups of subjects. These included 10 healthy controls, 10 controls with noncardiac pain, and three groups of 10 patients each with chronic stable angina, unstable angina at rest, or acute myocardial infarction. The concentration of fibrin-related antigen (normal range, 48 to 184 ng per milliliter) was normal in the control patients with noncardiac pain (63 to 202 ng per milliliter) and in patients with chronic stable angina (95 to 186), but it was increased in patients with unstable angina (401 to 2507) or acute myocardial infarction (470 to 1930) (P<0.001). D dimer concentrations in patients with unstable angina (178.3 to 310.6 ng per milliliter) or acute myocardial infarction (103.9 to 321.6) were higher than those in patients with chronic stable angina (28.6 to 52.1), in controls with noncardiac pain (44.7 to 53.1), and in healthy controls (40.4 to 50.3) (P<0.001). Concentrations of fibrin monomer were highest in patients with acute myocardial infarction (247.5 to 571.3 ng per milliliter) (P<0.001), intermediate in those with unstable angina (54.7 to 241.7) (P<0.001), and normal (normal range, 14.5 to 19.8 ng per milliliter) in controls with noncardiac pain (12.0 to 18.4) and patients with chronic stable angina (10.7 to 17.6). These findings suggest the presence of an active thrombotic process in patients with unstable angina at rest or acute myocardial infarction. The data do not prove that the coronary arteries were the site of the thrombotic process, but the observations are consistent with the hypothesis that thrombus formation may have an important role in the pathogenesis of these conditions. (N Engl J Med 1987; 317:1361–5.), INTRACORONARY thrombus formation has an important role in the genesis of acute transmural myocardial infarction.1 Coronary angioscopic and arteriographic evidence suggests that the syndrome of unstable angina is related to a partially occlusive thrombus.234 A quantitative assessment of the factors promoting clot formation and lysis and of the extent of clot formation and lysis in patients with the various manifestations of coronary artery disease could provide valuable information about the role of clot formation in these syndromes. Factors influencing platelet activation5 and thrombin generation6 in patients with unstable angina have recently been documented. However, there is little information about the… © 1987, Massachusetts Medical Society. All rights reserved.