Plasma fibrinogen level and long-term prognosis in Norwegian middle-aged patients with previous myocardial infarction. A 10 year follow-up study

Objectives. To investigate the prognostic value of plasma fibrinogen level amongst middle-aged survivors of myocardial infarction (MI). Design. Prospective cohort study. Settings. Determination of fibrinogen and other prognostic variables in MI patients recruited in a presumably stable phase of coronary heart disease ( CHD). Subjects. A total of 247 middle-aged CHD patients (54 women and 193 men) wh o had their first MI at age less than or equal to 60 (women) or less than o r equal to 55 (men) were recruited at least 3 months after (mean 2.1 years) the most recent MI. Main outcome measures. The primary endpoint was total mortality, and the se condary endpoint was cardiac deaths. The tertiary endpoint was major cardia c events (cardiac death, MI and cardiac arrest). Results. During a follow-up period of 10 years a total of 44 patients had d ied, 36 from cardiac causes. Major cardiac event occurred in 70 patients. A fter adjusting for age, ejection fraction (EF), total serum cholesterol (TC ), smoking and hypertension, patients in the top quartile of fibrinogen (>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 predicto r 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). Conclusions. A plasma fibrinogen level in the top quartile predicted cardia c death in middle-aged patients who had suffered MI.