P4637Elevated von Willebrand factor (VWF) and factor VIII are associated with higher clinical SYNTAX score in patients with stable coronary artery disease

Abstract Background Von Willebrand factor (VWF plays) central role in thrombogenesis, and circulates in a noncovalent complex with factor VIII (FVIII), acting as a transporter protein and stabilizer. VW factor protects FVIII from proteolytic inactivation and concentrate it at site of endothelial injury. Raised plasma VWF factor is detected in case of endothelial damage and it has been considered as a useful marker of endothelial dysfunction. Increased plasma FVIII has been found in venous thromboembolism and in some clinical conditions associated with chronic inflammation. The connection between FVIII and more incidence of arterial thrombosis is, partly, due to increased platelet adhesion/aggregation, induced by VWF at sites of arterial wall damage. The correlation between VWF factor, FVIII levels and acute coronary syndrome is well documented, but there are no available dates regarding relation between plasma levels of VW factor, FVIII and the severity of coronary artery disease according to SYNTAX I (SS) and Clinical SYNTAX score (CSS). Purpose The aim of this study was to determine the association between levels of VW factor and FVIII and the severity of coronary artery disease according to SS and CSS. Methods A total of 82 patients with symptoms of stable angina underwent coronary angiography and were divided into three groups according to SS and CSS: Group I (<22 points), Group II (23–32), Group III (>33). We calculated Clinical SYNTAX multiplying the value of SYNTAX score with the modified ACEF score, based on the patients' left ventricular ejection fraction, age and creatinine clearance derived using the Cockcroft–Gault equation. Results There were positive association between plasma levels of VW factor and severity of CAD according to SYNTAX I (Group I: 1.16±0.59, Group II: 1.52±0.62, Group III 1.49±0.80, Kruskal Wallis p=0.040) and Clinical SYNTAX score (Group I: 1.15±0.53, Group II: 1.38±0.72, Group III 1.57±0.75, Kruskal Wallis p=0.034). VW factor levels were significantly higher in Group II and Group III compared to Group I (SS: Mann- Whitney p=0.023 and 0.071, respectively), (CSS: p=0.251 and 0.009, respectively). We also found positive association between FVIII levels and severity of CAD according to SYNTAX I (Group I: 2.25±0.75, Group II: 2.21±0.53, Group III 2.97±0.95, Kruskal Wallis p=0.007) and Clinical SYNTAX score (Group I: 2.17±0.71, Group II: 2.26±0.68, Group III 2.89±0.87, Kruskal Wallis p=0.002). This study demonstrates that FVIII levels were significantly higher in Group III compared to Group I and Group II (SS: Mann- Whitney p=0.005 and 0.005, respectively), (CSS: p=0.001 and 0.014, respectively). The correlation between plasma levels of VW factor Conclusion Patients with stable angina pectoris and higher levels of VW and factor VIII had a higher Clinical SYNTAX and SYNTAX I score. Our study revealed that concomitant elevation in both VW and FVIII factors are a significant risk factor and predictor of more severe and extended CAD.