Relation of plasma D-dimer concentrations to coronary artery reperfusion before and after thrombolytic treatment in patients with acute myocardial infarction.
This study was designed to investigate the possible role of pre- and posttreatment plasma D-dimer concentration as a reflection of coronary artery thrombolysis. Blood was collected from 206 patients with angiographically documented acute coronary occlusion presenting within 6 hours of symptom onset who were enrolled in a prospective study comparing intravenous APSAC (30 U) (IV-APSAC) with intracoronary streptokinase (160,000 U) (IC-SK). D-dimer concentrations in 104 patients after IV-APSAC therapy were higher than in 90 patients after IC-SK (mean +/- standard error, 1,009 +/- 60 vs 603 +/- 45, p less than 0.001), but there was no difference in patients with and without reperfusion (1,096 +/- 88 vs 875 +/- 67, p = 0.1 for IV-APSAC, and 587 +/- 48 vs 634 +/- 95, p = 0.6 for IC-SK). The median concentrations before treatment were similar in the IV-APSAC and IC-SK groups (93 and 90 ng/ml, respectively). These were higher than the value in 25 ambulatory control subjects (72 ng/ml) but lower than in 29 post-AMI (6 to 30 hours) patients and in preoperative orthopedic patients (140 ng/ml each). There was no difference in D-dimer concentrations in patients with grade 0 or grade 1 coronary artery occlusion (median 85 vs 90 ng/ml) or in patients with or without ultimate successful reperfusion (median 85 vs 93 ng/ml).(ABSTRACT TRUNCATED AT 250 WORDS)
Brenner
B
B
Department of Medicine, University of Rochester School of Medicine, New York 14642.
Francis
C W
CW
Fitzpatrick
P G
PG
Rothbard
R L
RL
Cox
C
C
Hackworthy
R A
RA
Anderson
J L
JL
Sorensen
S G
SG
Marder
V J
VJ
D000328:Adult; D016255:Anistreplase; D003326:Coronary Circulation / Q000187:drug effects; D003331:Coronary Vessels; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000188:drug therapy; D010958:Plasminogen / Q000627:therapeutic use*; D011446:Prospective Studies; D013300:Streptokinase / Q000627:therapeutic use*
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D016255:Anistreplase; D010958:Plasminogen; D013300:Streptokinase