Fibrin monomer antigen. A novel marker of mortality in acute myocardial infarction

Abstract

Aims. A novel sensitive method for analyses of soluble fibrin monomer antigen was used to assess the predictive value of fibrin monomer when estimating mortality after acute myocardial infarction. Methods and Results. Fibrin monomer was measured in plasma samples from 293 patients enrolled in a randomized clinical trial of low molecular weight heparin (dalteparin) in acute myocardial infarction (the FRAMI trial). Samples taken on days 2 and 7 were analysed using the Enzymun-Test FM® (Boehringer Mannheim, Germany). Non-survivors had significantly higher fibrin monomer levels relative to survivors (day 2, median (min-max): 1.8 mg.l-1 (< 0.01-73.1) vs 0.4 mg.l-1 (< 0.01-103.5), P < 0.0001). Fibrin monomer levels were significantly associated with congestive heart failure (P < 0.001), enzymatic infarct size (P < 0.0001), dalteparin treatment (P < 0.001), and thrombolytic therapy (P = 0.016). The relationship between fibrin monomer and mortality remained statistically significant after adjustment for these variables. In logistic regression analyses, fibrin monomer levels, age and congestive heart failure were all independent predictors of fatal outcome. Conclusions. Increased fibrin monomer level is an independent predictor of mortality in patients with myocardial infarction. It allows further risk stratification when combined with known risk factors such as age and presence of congestive heart failure.