title: High plasma heparin cofactor II activity is associated with reduced incidence of in-stent restenosis after percutaneous coronary intervention.
abstract: BACKGROUND
  Thrombin plays an important role in the development of atherosclerosis and restenosis after percutaneous coronary intervention. Because heparin cofactor II (HCII) inhibits thrombin action in the presence of dermatan sulfate, which is abundantly present in arterial wall, HCII may affect vascular remodeling by modulating thrombin action. We hypothesized that patients with high plasma HCII activity may show a reduced incidence of in-stent restenosis (ISR).
  
  
  RESULTS
  Sequential coronary arteries (n=166) with NIR stent (Boston Scientific Corp) implantation in 134 patients were evaluated before, immediately after, and at 6 months after percutaneous coronary intervention. Patients were divided into the following groups: high HCII (> or =110%, 45 lesions in 36 patients), normal HCII (> or =80% and <110%, 81 lesions in 66 patients), and low HCII (<80%, 40 lesions in 32 patients). Percent diameter stenosis at follow-up in the high-HCII group (18.7%) was significantly lower (P=0.046) than that in the normal-HCII group (30.3%) or the low-HCII group (29.0%). The ISR rate in the high-HCII group (6.7%) was significantly lower than that in the low-HCII group (30.0%) (P=0.0039). Furthermore, multivariate analysis demonstrated that high plasma HCII activity is an independent factor in reducing the incidence of angiographic restenosis (odds ratio, 0.953/1% increase of HCII; 95% CI, 0.911 to 0.998).
  
  
  CONCLUSIONS
  The results demonstrate that HCII may have a hitherto unrecognized effect in inhibiting ISR. The effect of HCII may be mediated by inactivating thrombin in injured arteries, thereby inhibiting vascular smooth muscle cell migration and proliferation.
authors.affiliation: Department of Medicine and Bioregulatory Sciences, University of Tokushima Graduate School of Medicine, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Takamori
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Azuma
authors.forename: Midori
authors.initials: M
authors.lastname: Kato
authors.forename: Shunji
authors.initials: S
authors.lastname: Hashizume
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Aihara
authors.forename: Masashi
authors.initials: M
authors.lastname: Akaike
authors.forename: Katsuya
authors.initials: K
authors.lastname: Tamura
authors.forename: Toshio
authors.initials: T
authors.lastname: Matsumoto
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D015844:Heparin Cofactor II / Q000032:analysis*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*
chemical_list: D015844:Heparin Cofactor II