Related Experiment Videos
Thrombogenic potential of human coronary atherosclerotic plaques
D Ardissino1, P A Merlini, K A Bauer
1Division of Cardiology, Ospedale Maggiore and University of Parma, Italy. ardis001@planet.it
Insights
Higher tissue factor in unstable coronary artery disease plaques correlates with increased thrombin generation, suggesting a link to plaque thrombogenicity and rupture risk.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Biochemistry
Background:
- Tissue factor (TF) initiates blood coagulation and is elevated in coronary atherosclerotic plaques of patients with unstable coronary artery disease.
- The association between TF levels and thrombotic response following in vivo plaque rupture remains unclear.
Purpose of the Study:
- To investigate the relationship between tissue factor content in coronary atherosclerotic plaques and the thrombotic response in patients with stable versus unstable coronary artery disease.
- To assess thrombin generation across coronary lesions before and after plaque removal.
Main Methods:
- Prothrombin fragment 1 + 2 (F1+2), a marker of thrombin generation, was measured in intracoronary blood samples from 40 patients undergoing directional coronary atherectomy.
- Blood samples were collected proximally and distally to the atherosclerotic plaque before and after the procedure.
- Tissue factor content of the plaque was correlated with the increase in thrombin generation across the lesion.
Main Results:
- Before atherectomy, plasma F1+2 levels significantly increased across the lesion in patients with unstable coronary disease but not in stable disease (P =.0021).
- After plaque removal, a significant increase in F1+2 across the lesion was observed only in patients with unstable coronary disease (P =.036).
- A correlation was found between plaque tissue factor content and the increase in thrombin generation across the lesion (rho = 0.33; P =.038).
Conclusions:
- Elevated tissue factor in plaques from patients with unstable coronary artery disease is associated with increased local thrombin generation.
- This finding suggests a direct link between tissue factor content and the in vivo thrombogenicity of coronary atherosclerotic plaques.
- The study highlights the role of tissue factor in the thrombotic complications of unstable coronary artery disease.
Abstract:
Higher levels of tissue factor (the initiator of blood coagulation) have been found in coronary atherosclerotic plaques of patients with unstable coronary artery disease, but it is not established whether they are associated with a different thrombotic response to in vivo plaque rupture. In 40 patients undergoing directional coronary atherectomy, prothrombin fragment 1 + 2, a marker of thrombin generation, was measured in intracoronary blood samples obtained proximally and distally to the coronary atherosclerotic plaque before and after the procedure. Before the procedure, plasma prothrombin fragment 1 + 2 levels were significantly increased across the lesion in patients with unstable, but not in those with stable, coronary disease (unstable, median increase, 0.37 nM; range, -0.35-1.16 nM) (stable, median increase, -0.065 nM; range, -0.58-1.06 nM) (P =.0021). After plaque removal, an increase in prothrombin fragment 1 + 2 across the lesion was observed only in patients with unstable coronary disease (unstable, median increase, 0.25 nM; range, -1.04-4.9 nM) (stable, 0.01 nM; range, -0.48-3.59 nM) (P =.036)]. There was a correlation between the tissue factor content of the plaque and the increase in thrombin generation across the lesion (rho = 0.33; P =.038). The higher tissue factor content found in plaques obtained from patients with unstable coronary disease was associated with a local increase in thrombin generation, thus suggesting a link with the in vivo thrombogenicity of the plaque.