Factor XIII and Other Biomarkers in ST Segment Elevation Myocardial Infarction (eXIST)

May 18, 2022 updated by: Vittorio Pengo, University of Padova

In medical practice, a combination of clinical exam, electrocardiograms, circulating biomarkers, and imaging is used to gain insights on the prognosis after myocardial infarction. Novel molecular non-invasive tools are needed that help clinicians overcome the adverse events of post-myocardial infarction remodelling and thereby achieve improved therapy for its prevention.

Coagulation factor XIII (FXIII) decay has been linked to major adverse cardiac events (MACE) in patients with acute coronary syndromes. Given the correlation between both intramyocardial haemorrhage and microvascular damage with acute phase complications in ST-elevation myocardial infarction, we hypothesise that excessive FXIII decay within the first week may predict acute phase outcomes in these patients. If this holds true, FXIII determination could be used as diagnostic and prognostic tool.

Study Overview

Status

Completed

Conditions

Detailed Description

Background:

The reduction of mortality in acute myocardial infarction (AMI) is achieved by the efficacy of the current therapeutic strategies focused on an early reopening of the culprit coronary artery, by either medical or mechanical reperfusion. Primary percutaneous coronary intervention (PCI) represents the most effective way to limit infarct size and reduce transmural extension of necrosis. Although coronary artery recanalization represents the most effective way to reduce infarct size, the process of reperfusion may itself produce a series of consequences including intramyocardial haemorrhage (IMH) and microvascular injury (MVO) contributing to the 'no reflow' phenomenon. MVO is an early event followed by intramyocardial haemorrhage that plays a role later in reperfusion injury. Both luminal obstruction (microvascular damage by neutrophil plugging, platelets and emboli) and external compression (by oedema and haemorrhage) are allegedly linked with no-reflow, however, the real mechanism underlying this complex time-sensitive phenomenon remains to be fully understood. MVO and IMH in ST-elevation myocardial infarction are independent predictor of adverse left ventricle remodelling, independently of the initial infarct size, and predict MACE.

The diagnosis of no-reflow is usually made when post-procedural thrombolysis in myocardial infarction (TIMI) flow is <3, or in the case of a TIMI flow of 3 when myocardial blush grade is 0 or 1, or when ST resolution within 4 h of the procedure is <70%. It can be assessed using cardiac magnetic resonance (CMR) techniques, where they appear as dark zones on delayed post-contrast sequences or contrast echocardiography.

FXIII is a protransglutaminase that becomes activated by thrombin and catalyses the formation of crosslinked fibrin mesh in the final stage of the clotting cascade. Blood coagulation FXIII is thought to play a role in wound healing and tissue repair. FXIII is present in plasma, platelets, monocytes, and macrophages, all of which are involved in infarct healing. In an experimental model, mice lacking FXIII suffer from impaired wound healing and fatal rupture of the left ventricle after myocardial infarction. This phenomenon was observed in 100% of homozygous and, interestingly, in 100% of the heterozygous FXIII-knockout mice, despite a FXIII plasma level of 70%. Replenishment of FXIII during the 5-day acute and subacute period of infarct healing restored survival rates of FXIII-deficient mice to that of wild-type mice. In addition, reduced FXIII activity imaged via single photon emission computed tomography predicted adverse infarct healing after MI in mice. In contrast, increased intracardiac FXIII activity via induction of high FXIII zymogen plasma levels improved cardiac healing. Moreover, FXIII levels were significantly diminished in myocardial biopsies of human ruptured MI. In a case series of 25 patients with acute MI, a mean decrease of initially normal FXIII plasma values by 25% was reported during the first week after the ischemic event. During the first week after MI, an acute phase reduction in FXIII plasma levels has been described, with the nadir of reduction on day 3-6 after the acute event.

FXIII thus seems to mediate the formation of a well-cemented scar, reducing MVO and IMH and improve healing and left ventricle remodelling.

Aim of the study:

We will perform a prospective observational study to identify how the differences in FXIII levels in ST-elevation myocardial infarction patients relate with intramyocardial haemorrhage and microvascular damage as detected by cardiac magnetic resonance.

Study Type

Observational

Enrollment (Actual)

35

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Italy
    • PD
      • Padua, PD, Italy, 35128
        • University of Padua, Cardiology Clinic

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

Patients that present in the Padova University Hospital Coronary Care Unit with a ST-elevation myocardial infarction will be screened

Description

Inclusion Criteria:

  • patients with the clinical presentation of ST-elevation myocardial infarction within 12 h of symptom onset and with persistent ST-segment elevation or new or presumed new left bundle branch block and undergoing primary percutaneous coronary intervention (PCI)

Exclusion Criteria:

  • patients with late presentation ST-elevation myocardial infarction (beyond the first 12h after onset of symptoms) or ineligible for mechanical reperfusion therapy
  • contraindications to cardiac magnetic resonance
  • pregnancy

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
FXIII decay correlation with intramyocardial haemorrhage/microvascular damage
Time Frame: average of 6 days
FXIII decay will be correlated with intramyocardial haemorrhage/microvascular damage as assessed by cardiac magnetic resonance imaging
average of 6 days

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Padova

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

November 1, 2015

Primary Completion (Actual)

March 1, 2019

Study Completion (Actual)

January 1, 2022

Study Registration Dates

First Submitted

May 1, 2018

First Submitted That Met QC Criteria

May 1, 2018

First Posted (Actual)

May 14, 2018

Study Record Updates

Last Update Posted (Actual)

May 25, 2022

Last Update Submitted That Met QC Criteria

May 18, 2022

Last Verified

May 1, 2022

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • eXIST-DCTV

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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