Soluble Fibrin Monomer Complex and Prediction of Cardiovascular Events in Atrial Fibrillation: The Observational Murcia Atrial Fibrillation Project

• Published in: Journal of general internal medicine : JGIM 2018-06, Vol.33 (6), p.847-854
• Main Authors: Rivera-Caravaca, José Miguel, Roldán, Vanessa, Romera, Marta, Esteve-Pastor, María Asunción, Valdés, Mariano, Lip, Gregory Y. H., Vicente, Vicente, Marín, Francisco
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Biomarkers; Cardiac arrhythmia; Cardiovascular diseases; Fatalities; Fibrillation; Fibrin; Health risk assessment; Health risks; Heart; Heart diseases; Internal Medicine; Ischemia; Medicine; Medicine & Public Health; Monomers; Mortality; Original Research; Patients; Performance prediction; Prostheses; Prosthetic valves; Reclassification; Rheumatic heart disease; Stability; Stroke; Surgery; Vitamin K
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-017-4279-4

Background Soluble fibrin monomer complex (SFMC) is a biomarker of fibrin formation abnormally elevated in clinical situations of hypercoagulability. Objective We investigated the association and predictive performance of SFMC for stroke, adverse cardiovascular events, cardiovascular mortality and all-cause mortality in a cohort of patients with atrial fibrillation (AF) receiving vitamin K antagonist (VKA) anticoagulant therapy. Design During the second semester of 2007, we included 1226 AF outpatients stable on VKAs (INR 2.0–3.0) over a period of 6 months. SFMC levels were assessed at baseline. During 6.5 (IQR 4.4–8.0) years of follow-up, we recorded all ischemic strokes, adverse cardiovascular events (composite of stroke, acute heart failure, acute coronary syndrome and cardiovascular death), cardiovascular deaths and all-cause deaths. Participants All patients were recruited consecutively. We excluded patients with rheumatic mitral valves, prosthetic heart valves, acute coronary syndrome, stroke, hemodynamic instability, hospital admissions or surgical interventions within the preceding 6 months. Main Measures SFMC levels were measured in plasma by immunoturbidimetry in an automated coagulometer (STALiatestFM, Diagnostica Stago, Asnieres, France). Key Results We recorded 121 (1.52%/year) ischemic strokes, 257 (3.23%/year) cardiovascular events, 67 (0.84%/year) cardiovascular deaths and 486 (6.10%/year) all-cause deaths. SFMC >12 μg/mL was not associated with stroke but was associated with higher risk of cardiovascular events (HR 1.72, 95% CI 1.31–2.26), cardiovascular mortality (HR 2.16, 95% CI 1.30–3.57) and all-cause mortality (HR 1.26, 95% CI 1.03–1.55). When SFMC >12 μg/mL was added to the CHA 2 DS 2 -VASc, there were significant improvements in predictive performance, sensitivity and reclassification for adverse cardiovascular events (c-index: 0.645 vs. 0.660, p  = 0.010; IDI = 0.013, p