INCREASED PLASMA-CONCENTRATION OF FIBRIN MONOMER IN ACUTE MYOCARDIAL-INFARCTION WITH EARLY REPERFUSION

Objective To assess whether plasma fibrin monomer (FM) concentration, a marker of thrombin activity, is increased in the first hours after a cute coronary occlusion and whether there are differences between pati ents with and without early reperfusion. Design Thirty-five consecutiv e patients with acute myocardial infarction (AMI) and early coronary a ngiography were studied prospectively. Methods Plasma FM samples taken on admission (< 6 h after onset of chest pain) and 6-14 h after onset of chest pain were analysed using a specific enzyme immunoassay. All of the patients were anticoagulated with heparin intravenously.Results Of the 35 patients, 28 had angiographically documented reperfusion wi thin the first 6 h, whereas seven patients had no early reperfusion. F M concentrations were measured in the reference range (less than or eq ual to 3.6 mg/l) within the first 6 h in 32 of the 35 patients, At 6-1 4 h FM concentrations were elevated in the reperfusion group (median 4 .56 mg/l), but not in the group without reperfusion (median 1.6 mg/l, P = 0.0063). Using a threshold value of 3.0 mg/l, sensitivity and spec ificity of FM for the non-invasive recognition of early reperfusion we re 78 and 83%, respectively. The specificity was similar to that for t roponin T and higher than the creatinine kinase MB specificity. Conclu sions FM plasma concentrations are elevated in patients with AMI and e arly reperfusion. With a single blood sample 6-14 h after onset of che st pain, FM analysis is useful for the non-invasive detection of early reperfusion after AMI.