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Thrombin Generation and Activity During Coronary Angioplasty: Influence of Angiographic Lesion Morphology
1Mount Sinai School of Medicine, Division of Cardiology, Box 1030, One Gustave Levy Place, New York, NY, 10029-6574, USA.
Insights
Percutaneous coronary interventions activate the coagulation cascade, with both simple and complex coronary lesions showing similar thrombin generation. Complex lesions, however, exhibit a slightly greater increase in thrombin activity post-procedure.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Hemostasis and Thrombosis
Background:
- Balloon angioplasty for coronary lesions can trigger intracoronary thrombin generation.
- The relationship between pre-intervention lesion morphology and coagulation cascade activation remains unclear.
- Angiographic lesion morphology may indicate the presence of thrombus, influencing procedural outcomes.
Purpose of the Study:
- To investigate the link between coronary atherosclerotic plaque injury, lesion morphology, and coagulation cascade activation.
- To determine if angiographic lesion morphology predicts the extent of coagulation activation after percutaneous transluminal coronary angioplasty (PTCA).
Main Methods:
- Measured biochemical markers of thrombin generation (prothrombin fragment F1+2) and activity (fibrinopeptide A; FPA) in coronary blood.
- Assessed markers before, and 1 and 10 minutes after PTCA in patients with simple and complex coronary lesion morphologies.
- Compared marker levels between groups and correlated them with lesion complexity.
Main Results:
- No significant difference in the incidence of elevated thrombin generation (F1+2) or activity (FPA) between simple and complex lesions post-PTCA (~33% in both).
- Patients with complex lesions showed a modest increase in FPA levels 10 minutes post-PTCA compared to pre-PTCA levels (p=0.05).
- Patients with simple lesions had similar FPA levels before and after PTCA.
Conclusions:
- Angiographically simple and complex coronary lesions exhibit similar rates of thrombin generation and activity post-PTCA.
- Complex lesions may be associated with a slightly greater post-procedural increase in thrombin activity.
- Percutaneous coronary interventions, regardless of lesion morphology, can activate the coagulation cascade.
Abstract:
OBJECTIVE: To investigate the relationships between coronary atherosclerotic plaque injury, lesion morphology, and activation of the coagulation cascade. BACKGROUND: Balloon angioplasty of coronary lesions may result in intracoronary thrombin generation and activity. It is unknown whether the angiographic morphology of the lesion prior to intervention, an indicator of the presence of thrombus in the lesion, is a determinant of the degree of coagulation cascade activation. METHODS AND RESULTS: Biochemical markers of thrombin generation (prothrombin fragment F1+2) and thrombin activity (fibrinopeptide A; FPA) were measured in coronary blood before, 1 and 10 minutes after percutaneous transluminal coronary angioplasty (PTCA) in 24 patients with an angiographically complex lesion morphology and 24 patients with an angiographically simple lesion morphology. Using previously defined criteria, 18 of the 48 patients (38%) demonstrated a significant rise in coronary plasma F1+2; 8 of these 18 (44%) had simple and 10 of 18 (55%) had complex angiographic lesion morphologies (p=NS). With respect to thrombin activity, 15 of the 48 patients (31%) demonstrated a significant rise in coronary plasma FPA; 7 of these 15 patients (47%) had a simple lesion morphology and 8 (53%) had a complex morphology (p=NS). When analyzed as a group, patients with complex lesion morphologies demonstrated a small elevation in coronary plasma levels of FPA 10 minutes post-PTCA (median 3.2 ng/ml, 95% CI 2.4Ð5.8 ng/ml) in comparison to the levels measured proximal to the lesion pre-PTCA (median 2.1 ng/ml, 95% CI 1.6Ð3.5 ng/ml; p=0.05). In contrast, in the group of patients with simple lesion morphologies, the plasma FPA levels proximal to the lesion pre-PTCA (median 2.1 ng/ml, 95% CI 1.5 to 3.9 ng/ml) were similar to those measured 10 minutes after the procedure (median 2.0 ng/ml, 95% CI 1.5 to 6.3 ng/ml; p=NS). CONCLUSIONS: In comparison to patients with angiographically complex lesions, patients with angiographically simple lesions demonstrate a similar incidence (~33%) of elevated coronary plasma thrombin generation (F1+2) and activity (FPA) after PTCA. As a group, patients with angiographically complex lesions (irregular borders, overhanging edges, filling defects) demonstrate a slightly greater increase in thrombin activity in comparison to patients with simple lesion morphologies. Percutaneous coronary interventions of lesions with a wide variety of angiographic morphologies are prone to result in activation of the coagulation cascade.