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

Aims A novel sensitive method for analyses of soluble fibrin monomer antige n 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 he parin (dalteparin) in acute myocardial infarction (the FRAMI trial). Sample s taken on days 2 and 7 were analysed using the Enzymun-Test FM(R) (Boehrin ger Mannheim, Germany). Non-survivors had significantly higher fibrin monom er 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 w ere significantly associated with congestive heart failure (P<0.001), enzym atic infarct size (P<0.0001), dalteparin treatment (P<0.001), and thromboly tic therapy (P=0.016). The relationship between fibrin monomer and mortalit y 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 m ortality in patients with myocardial infarction. It allows further risk str atification when combined with known risk factors such as age and presence of congestive heart failure.