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Published on: May 14, 2013
D-dimer increase after percutaneous transluminal angioplasty and clinical recurrence after primary revascularization
D Prisco1, E Antonucci, S Fedi
1Thrombosis Center, Department of Medical and Surgical Critical Care, University of Florence, Italy. d.prisco@dfe.unifi.it
Insights
Early changes in plasminogen activator inhibitor-1 (PAI-1) and D-Dimer after angioplasty predict recurrence in acute myocardial infarction patients. Elevated D-Dimer post-procedure indicates higher restenosis risk, while PAI-1 changes are less predictive in acute settings.
Area of Science:
- Cardiology
- Vascular Biology
- Biomarkers
Background:
- Plasminogen activator inhibitor-1 (PAI-1) activity increase post-elective coronary angioplasty correlates with recurrence in chronic coronary artery disease.
- Understanding PAI-1 and D-Dimer behavior after revascularization in acute myocardial infarction (AMI) is crucial for predicting outcomes.
Purpose of the Study:
- To evaluate PAI-1 and D-Dimer dynamics post-angioplasty and stenting in AMI patients.
- To determine if these biomarker changes predict subsequent clinical recurrence.
- To compare these dynamics between primary angioplasty for AMI and elective angioplasty.
Main Methods:
- Two patient groups were studied: 54 undergoing primary angioplasty for AMI (Group 1) and 48 undergoing elective angioplasty (Group 2).
- PAI-1 activity and D-Dimer levels were measured at baseline and post-procedure.
- Clinical recurrence and restenosis were assessed, with control angiography performed as needed.
Main Results:
- Baseline D-Dimer and PAI-1 levels were significantly higher in the AMI group (Group 1) compared to the elective group (Group 2).
- A post-procedural D-Dimer increase was significantly associated with recurrence in Group 1 (61% vs. 25%).
- In Group 2, a lack of PAI-1 decrease post-angioplasty was linked to recurrence (83% vs. 38%).
Conclusions:
- Early PAI-1 changes are less predictive of recurrence after primary angioplasty in AMI compared to elective angioplasty.
- Increased D-Dimer post-procedure in AMI patients suggests heightened clotting activation and fibrin formation, correlating with recurrence.
- Further investigation into clotting activation markers is warranted for AMI patients undergoing angioplasty.
Abstract:
It has been reported that the increase of plasminogen activator inhibitor-1 activity immediately after elective coronary angioplasty is related to subsequent clinical recurrence in patients with chronic coronary artery disease. The aims of our study were to evaluate the behavior of plasminogen activator inhibitor-1 and D-Dimer after revascularization in acute myocardial infarction patients treated with angioplasty and stenting and if this behavior is predictive of subsequent clinical recurrence. D-Dimer and plasminogen activator inhibitor-1 activity were evaluated in two groups of patients. Group 1 consisted of 54 consecutive patients undergoing primary angioplasty for acute myocardial infarction and Group 2 consisted of 48 patients undergoing elective angioplasty. Patients underwent control coronary angiography only in the case of clinical recurrence and/or positivity of provocative tests. D-Dimer and plasminogen activator inhibitor-1 baseline levels were significantly higher in group 1 than in group 2 (P<0.0005 and P<0.05, respectively). The percentage of group 1 patients with a post-procedural increase in D-Dimer was significantly higher among those with subsequent clinical recurrence with restenosis (61%) than among those with no recurrence (25%, P<0.05). No difference was observed in group 2. The percentage of group 2 patients in whom no decrease of plasminogen activator inhibitor-1 was observed after angioplasty was significantly higher (83%) among those with subsequent recurrence than among those with no recurrence (38%, P<0.05). This pattern was not observed in group 1. In conclusion, the role of early changes in plasminogen activator inhibitor-1 in predicting clinical recurrence after primary angioplasty in acute myocardial infarction patients is less clear than that observed after elective angioplasty. A significant role seems to be played by a more-marked clotting activation with increased fibrin formation.
