Correlation between coronary morphology and molecular markers of fibrinolysis in unstable angina pectoris.
BACKGROUND
In acute coronary syndromes, marked alterations of coagulation and fibrinolysis have been observed, but no data are available concerning a possible relation to coronary stenosis morphology.


METHODS
Thirty one patients with unstable angina pectoris were included. Culprit stenosis morphology judged from coronary angiography was graded using the modified ACC/AHA classification. Molecular and functional markers of hemostasis and fibrinolysis were determined from venous plasma samples obtained at admission.


RESULTS
Patients with unstable angina pectoris had a moderate procoagulant state, especially a contact phase activation compared with age-matched controls (factor XII 93.9 +/- 5.6 vs 112.8 +/- 5.4%; P < 0.05; high molecular weight kininogen 55.3 +/- 5.4 vs 86.1 +/- 6.5%; P < 0.01). Thrombin-antithrombin (TAT) was not significantly elevated (7.6 +/- 1.9 vs 4.0 +/- 0.5 microg/l). Elevated plasminogen activator mass concentration (16.6 +/- 2.1 vs 5.4 +/- 0.6 ng/ml; P < 0.01) and plasminogen activator inhibitor (PAI) activity (9.9 +/- 3.0 vs 5.6 +/- 3.0 AU/ml; P < 0.05) indicated an alteration of the fibrinolysis. Complexity of coronary stenosis was positively correlated with tissue-type plasminogen activator (TPA) mass concentration (P < 0.01) and PAI activity (P < 0.05). No association was found to markers of a hypercoagulative state.


CONCLUSIONS
These findings indicate a relation between alterations of the fibrinolytic system and coronary morphology, whereas the acute changes of coagulation occur independently of culprit stenosis complexity.
Hoffmeister
H M
HM
Medizinische Universitätsklinik, Abteilung Innere Medizin III, Eberhard-Karls-Universität, Tübingen, Germany.
Jur
M
M
Helber
U
U
Fischer
M
M
Heller
W
W
Seipel
L
L
D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000097:blood* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015415:Biomarkers / Q000032:analysis; D017023:Coronary Angiography; D003327:Coronary Disease / Q000097:blood / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005174:Factor XII / Q000032:analysis*; D005260:Female; D005342:Fibrinolysis / Q000502:physiology; D006801:Humans; D007704:Kininogens / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood*; D012016:Reference Values; D012680:Sensitivity and Specificity
D015415:Biomarkers; D007704:Kininogens; D017395:Plasminogen Activator Inhibitor 1; D005174:Factor XII