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European Heart Journal Advance Access published online on January 26, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi104
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved

Clinical research

Predictors of the rise in vWF after ST elevation myocardial infarction: implications for treatment strategies and clinical outcome: An ENTIRE-TIMI 23 substudy

Kausik K. Ray 1*, David A. Morrow 2, C. Michael Gibson 2, Sabina Murphy 2, Elliott M. Antman 2, Eugene Braunwald 2, and for the ENTIRE-TIMI 23 Study Group

1 The TIMI Study Group and Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital/Harvard Medical School, 350 Longwood Avenue, First Floor, Boston, MA 02115, USA
2 The TIMI Study Group and Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital/Harvard Medical School, Boston, MA, USA

* To whom correspondence should be addressed.
Kausik K. Ray, E-mail: kkray{at}partners.org


  Abstract

Aims Prior studies suggest that acute coronary syndromes (ACSs) are associated with endothelial activation and that this is of prognostic significance. We hypothesized that endothelial activation, as measured by a rise in von Willebrand Factor ({Delta}vWF), was influenced by the thrombolysis in myocardial infarction flow grade (TFG), the corrected TIMI frame count (CTFC) and the choice of anticoagulant therapy after fibrinolysis in ST elevation myocardial infarction (STEMI).

Methods and results Data were drawn from the enoxaparin and tenecteplase tissue plasminogen activator (TNK-tpa) with or without GPIIb/IIIa inhibitor as the reperfusion strategy in the STEMI trial (ENTIRE-TIMI 23). Three hundred and fourteen patients had serial measurements of vWF (baseline and 48-72 h) and angiographic data available. TFG < 3 (P = 0.0042) or CTFC ≥ 40 at 60 min (P = 0.0035) were associated with a higher {Delta}vWF. {Delta}vWF ≥ 75th percentile was associated with a higher incidence of death or myocardial infarction (MI) at 30 days, compared with <75th percentile (11.2 vs. 4.1%, P = 0.027). Enoxaparin independently reduced the {Delta}vWF (P = 0.019) and also the composite of death or MI (OR 0.33, 95% CI 0.12-0.91, P = 0.03) compared with unfractionated heparin.

Conclusion In STEMI treated by fibrinolysis, coronary flow at 60 min and choice of adjunctive anticoagulant appear to be independent determinants of {Delta}vWF. Enoxaparin is independently associated with a reduction in {Delta}vWF and a reduction in death or MI. The clinical benefits of enoxaparin as an adjunctive treatment in STEMI may be mediated in part by a reduction in vWF release.

Keywords: vWF; TIMI flow grade; Corrected TIMI frame count; ST elevation myocardial infarction; Endothelial activation.
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