Tissue factor and coagulation factor VII levels during acute myocardial infarction: association with genotype and adverse events.

Objective— We investigated in patients with ongoing myocardial infarction (MI) whether coagulation factor VII (FVII) and tissue factor (TF) levels are affected at admission by genetic components and whether they may predict subsequent cardiovascular events. Methods and Results— 256 patients admitted for MI were evaluated for FVII and TF antigen levels before any treatment at entry, and were genotyped for FVII and TF polymorphisms. FVII gene insertions at –323, 11293 and the –402G/A change predicted FVII levels and explained 14% of variance. The –603 TF gene polymorphism failed to affect significantly TF levels (P=0.07). These variables were correlated with the incidence of death (36 patients) and reinfarction (9 patients) after a median follow-up of 397 days. Events were independently predicted by FVII (HR 2.1, 95% CI 1.2 to 5.7) and TF (HR 4.1, 95% CI 2 to 11) levels. Composite end point was significantly worse when both parameters were above the receiver-operating characteristics (ROC) values (HR 8.3, 95% CI 5 to 18, compared with FVII and TF below), and above the ROC value of TF (>630 pg/mL) it differed among FVII genotype groups. Conclusions— Admission FVII and TF antigen levels, partially predicted by polymorphisms, are independent predictors of mortality and reinfarction in patients with acute MI. Admission FVII and TF antigen, partially predicted by polymorphisms, were independent predictors of composite end point (mortality and reinfarction), which was even worse in patients showing both parameters simultaneously elevated. FVII genotype influenced outcome only in patients with high TF values.