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| Year : 1983 | Volume
: 29
| Issue : 4 | Page : 233-5 |
Prognostic value of plasma fibrinogen in myocardial infarction.
Gopal RR, Saxena KK, Gupta BB, Srivastava SS, Srivastava RK, Prasad DN
How to cite this article:
Gopal R R, Saxena K K, Gupta B B, Srivastava S S, Srivastava R K, Prasad D N. Prognostic value of plasma fibrinogen in myocardial infarction. J Postgrad Med 1983;29:233 |
How to cite this URL:
Gopal R R, Saxena K K, Gupta B B, Srivastava S S, Srivastava R K, Prasad D N. Prognostic value of plasma fibrinogen in myocardial infarction. J Postgrad Med [serial online] 1983 [cited 2023 Jun 10];29:233. Available from: https://www.jpgmonline.com/text.asp?1983/29/4/233/5508 |
Need of knowing the prognosis of patients suffering from myocardial infarction arises while evaluating the effects of different methods of treatment and comparing results from different centers.[8] A number of formulations have been devised in the past to predict the prognosis of such patients. `Coronary prognostic index' was the term first coined by Peel et al[8] for such formulations which involved scoring systems for so many varied and complex data. Likewise, plasma fibrinogen (PF), which rises consistently following experimental[6], [12] as well as clinical[1], [9] myocardial damage, has been tried earlier by Losner and Volk[6], in 1956 and Eastham and Morgan[3] in 1963 to be employed as prognostic indicator in patients with myocardial infarction. However, results of these investigators remained uncorroborated. We have previously reported that PF is a useful indicator of severity of myocardial necrosis induced by isoprenaline challenge in rats[11] and in coronary artery ligated dogs.[5] To confirm these experimental and clinical observations of earlier workers, the present investigation was envisaged to assess the significance of PF as a prognostic indicator in patients with myocardial infarction.
The study was conducted on sixty patients, including six females, and aged between 35 and 75 years, admitted to the intensive coronary care unit of SVBP Hospital, Meerut, with the diagnosis of acute myocardial infarction. The diagnosis was confirmed by electrocardiography. Blood samples were collected from antecubital vein for five consecutive days for estimating PF[4] and serum glutamic oxaloacetic transaminase (SGOT)[10] levels.
Detailed information about the patients was collected to calculate the coronary prognostic indices of Norris et al[7] and Chapman and Gray.[2] Six criteria as described by Norris et al,[7] i.e., age, position of infarct, systolic blood pressure on admission, heart size, lung fields, and history of previous ischaemia were determined in each patient. Site of infarction was ascertained by ECG and heart size by skiagram of the chest, while the grade of pulmonary congestion was assessed by auscultation. To calculate the prognostic index of Chapman and Gray,[2] three factors were determined, (a) SGOT level, (b) presence or absence of cardiogenic shock and/or (c) oliguria.
Out of the sixty patients, sixteen had a past history of myocardial ischaemia. Eighteen patients developed post-infarction complications viz. cardiac arrhythmias, cardiogenic shock and/or oliguria during their stay in the hospital. Out of these, eight patients suffered from cardiogenic shock as well as oliguria. Anterior transmural infarction was found to be the commonest type of infarction (34 patients). Total twelve patients died before leaving the wards. None of the female patients died in the hospital.
In these patients scores of coronary prognostic indices ranged between 0-76 and 2-16.7, when calculated according to Chapman and Gray[2] and Norris et al,[7] respectively exhibiting variable severity of myocardial infarction, while peak PF ranged from 110-680 mg% [Table - 1]. Plasma fibrinogen attained its peak value on the 3rd day following myocardial infarction. Pearson's coefficients of correlation (r) between peak values of PF and coronary prognostic indices were + 0.599 (p < 0.001) and + 0.633 (p < 0.001) for indices of Norris et al[7] and that of Chapman and Gray[2] respectively, which showed that the rise in PF correlated well with the increase in scores of coronary prognostic indices reflecting the severity of myocardial damage.
Furthermore no patient could survive whose peak PF reached above 600 mg% while no patient died in whom peak PF remained less than 560 mg%. It is worth noting from [Table - 1] that the number of patients where mortality could not be predicted on the basis of PF remained interestingly low.[7] On the other hand, the number of patients where mortality was unpredictable on the basis of coronary prognostic indices was decisively high (43 and 48) exhibiting the superiority of PF over prognostic indices. Thus the present work explicitly demonstrates that PF may prove' to be a better indicator of prognosis in patients with acute myocardial infarction. However, the status of PF as prognostic indicator could only be recognised after a much morn extended investigation.
The study was financially supported by ICMR, New Delhi.
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| 2. | Chapman, B. L. and Gray, C. H.: Prognostic index for myocardial infarction treated in coronary care unit. Brit. Heart J., 35: 135-141, 1973. |
| 3. | Eastham, R. D. and Morgan, E. H.: Plasma fibrinogen levels in coronary artery disease. Lancet, 11: 1196-1197, 1963. |
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| 9. | Rawles, J. M., Warlow, C. and Ogston, D.: Fibrinolytic activity of arm and leg veins after femoral shaft fracture and acute myocardial infarction. Brit. Med. J., ii: 61-62, 1975. |
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| 11. | Saxena, K. K., Gupta, B., Srivastava, V. K., Kulshrestha, V. K. and Prasad, D. N.: On significance of plasma fibrinogen level to assess severity of myocardial damage, an experimental study. Ind. J. Expt. Biol., 17: 600-602, 1979. |
| 12. | Saxena, K. K.. Srivastava, R. K. and Prasad, D. N.: Myocardial damage vis-a-vis plasma fibrinolytic activity and fibrinogen level-an experimental study. Ind. J. Med. Res., 70: 263-267, 1979. |
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