Fibrinogen: Associations with cardiovascular events in an outpatient clinic

Background Fibrinogen, known to influence the coagulation process, is an independent risk factor for coronary artery disease (CAD). However, its association with myocardial infarction (MI) and its predictive potential for short-term mortality, in an ongoing clinical practice, has not been characterized. Objectives In a high-risk outpatient practice we sought to demonstrate whether baseline fibrinogen levels related to MI rather than CAD alone, and whether baseline serum fibrinogen levels predicted mortality over a short-term follow-up. Methods and Results From a total of 2126 patients with baseline fibrinogen measurements (mean age, 56 ± 12 years, 35% female), 1187 patients with CAD (n = 606 with MI) and 939 patients without CAD were evaluated in an active preventive cardiology unit of a large city hospital. Logistic regression models were used to determine the association of fibrinogen with differing CAD presentations. Fibrinogen quartile showed a significant correlation with CAD both univariately and after adjustment for Framingham risk score (odds ratio [OR] = 1.22, P < .001). Fibrinogen levels were significantly associated with the presence of CAD and history of MI (adjusted OR = 1.25, P = .001). Fibrinogen did not show a significant association to CAD when MI was not considered in the analysis (OR = 1.01, P = .82). In this same clinical cohort, after a mean follow-up of 24 ± 13 months, 41 patients had died. Consistent with the observed association with MI, fibrinogen quartile showed a graded independent relation to mortality in a cohort of both men and women (hazard RATIO = 1.81, P < .001). Conclusions In the clinical setting of an outpatient clinic, fibrinogen was directly associated with the presence of MI and was revealed to be an independent short-term predictor of mortality. (Am Heart J 2002;143:277-82.)