[Contributory changes in variables of coagulation and fibrinolysis to the patency of coronary arteries in patients with acute myocardial infarction].
Plasma levels of fibrinopeptide A (FPA), D-dimer and tissue-plasminogen activator antigen (t-PA-Ag) were measured serially in 38 patients with acute myocardial infarction undergone emergency coronary angiography and/or PTCR (percutaneous transluminal coronary recanalization). A special attention has been focussed in the possible correlation of the variables of coagulation and fibrinolysis with the degree of patency of infarct-related coronary arteries (IRAs). Before PTCR, 26 patients with completely occluded IRAs had significantly higher plasma levels of FPA when compared with those of 12 patients with incompletely occluded IRAs (33.8 +/- 2.4 vs 11.0 +/- 1.3 ng/ml, mean +/- SD, p less than 0.05, respectively). Successful recanalization were resulted in 19 of 26 patients with completely occluded IRAs. Though plasma D-dimer levels significantly increased after PTCR both in patients with or without successful reperfusion, there were neither differences in the two groups before nor after PTCR (154.8 +/- 1.9 to 257.0 +/- 3.0 vs 131.6 +/- 4.8 to 254.9 +/- 4.1 ng/ml, mean +/- SD, respectively). Coronary angiography in 30 patients, performed about a month after the onset of acute myocardial infarction, revealed good patency (the stenosis was less than 90% evaluated according to the American Heart Association Committee Report in 1975) of IRAs in 17 patients and poor patency (the stenosis was 99% or 100%) of IRAs in 13 patients. The former patients had significantly higher plasma levels of t-PA-Ag after 24 hours from the onset than those of the latter patients (26.6 +/- 10.7 vs 17.4 +/- 4.2 ng/ml, mean +/- SD, p less than 0.05, respectively). These findings suggest that the increase in thrombin activity affects unfavorably the patency of IRAs in the evolving of myocardial infarction, and that the responsiveness of endothelial cells to acute phase stimuli such as thrombin and heparin affects favorably the patency of IRAs in the chronic phase; Elevated plasma levels of D-dimer do not necessarily indicate coronary thrombolysis.
Miyauchi
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Second Department of Internal Medicine, Faculty of Medicine, Kagoshima University.
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001777:Blood Coagulation; D003331:Coronary Vessels / Q000503:physiopathology*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005342:Fibrinolysis; D005344:Fibrinopeptide A / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000503:physiopathology* / Q000628:therapy; D010959:Tissue Plasminogen Activator / Q000032:analysis; D014654:Vascular Patency
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D005344:Fibrinopeptide A; D010959:Tissue Plasminogen Activator