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Release of platelet activation markers during coronary angioplasty
S Korovesis1, S Fredericks, D Holt
1Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.
Insights
Platelet activation occurs during coronary angioplasty, indicated by elevated markers like beta-thromboglobulin and platelet factor 4 before intervention. These markers decrease after balloon deflation, suggesting reduced platelet activation post-procedure.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Interventional Cardiology
Background:
- Previous studies inconsistently reported platelet activation during coronary angioplasty.
- Elevated serotonin levels were noted, but beta-thromboglobulin and platelet factor 4 were not consistently detected.
Purpose of the Study:
- To conduct a serial analysis of platelet activation markers.
- To simultaneously measure serotonin, beta-thromboglobulin, and platelet factor 4 levels.
- To analyze blood samples from the coronary artery and sinus during angioplasty.
Main Methods:
- Studied twenty patients undergoing elective coronary angioplasty.
- Measured beta-thromboglobulin, platelet factor 4, and serotonin levels.
- Collected samples from the coronary artery ostium and coronary sinus before and after balloon inflation.
Main Results:
- Beta-thromboglobulin and platelet factor 4 were elevated in all patients pre-angioplasty.
- Serotonin levels were elevated in 85% of patients before dilatation.
- Coronary sinus concentrations of all markers decreased post-inflation, with ratios indicating platelet activation, especially in complex lesions.
Conclusions:
- Systemic and coronary platelet activation occur before percutaneous transluminal coronary angioplasty.
- Post-balloon deflation, marker ratios tend to decrease or remain unchanged, reflecting the level of activation.
Background:
Authors of several studies have reported that activation of platelets occurs during coronary angioplasty, but consistent results have not been obtained. Levels of serotonin in coronary circulation have been found to be elevated during percutaneous transluminal coronary angioplasty but greater than normal concentrations of beta-thromboglobulin and platelet factor 4 have not been detected.
Objective:
To perform a serial analysis of platelet-activation markers with simultaneous measurements of levels of serotonin, beta-thromboglobulin and platelet factor 4 in blood samples from the coronary artery and coronary sinus of patients undergoing coronary angioplasty.
Methods:
Twenty patients undergoing elective coronary angioplasty were studied. Measurements of levels of beta-thromboglobulin, platelet factor 4, and serotonin in samples from the ostium of the coronary artery and the coronary sinus were performed immediately before angioplasty and after the first balloon deflation.
Results:
Concentrations of beta-thromboglobulin and platelet factor 4 in coronary artery and coronary sinus were elevated in all patients before dilatation, whereas concentrations of serotonin were elevated in 85% of the patients. Concentrations of all markers in coronary sinus decreased after the first inflation. The coronary-sinus: coronary-artery concentration ratios before dilatation for beta-thromboglobulin, platelet factor 4, and serotonin were > 1 for the majority of patients, particularly for those with complex culprit lesions, indicating that coronary activation of platelets was occurring. Ratios remained unchanged or decreased after the first inflation, depending on initial values.
Conclusions:
Both systemic and coronary activation occur in patients subjected to percutaneous transluminal coronary angioplasty before the onset of intervention. After balloon deflation the greater than normal baseline coronary-sinus:coronary-artery concentration ratios of all markers (beta-thromboglobulin, platelet factor 4 and serotonin) tend to decline or remain unchanged, depending on the level of activation.