Relevance of hemostasis on restenosis in clinically stable patients undergoing elective PTCA

Area of Science:

• Cardiovascular Medicine
• Hematology
• Interventional Cardiology

Background:

• Secondary coronary thrombus formation is a suspected factor in restenosis post-percutaneous transluminal coronary angioplasty (PTCA).
• Systemic hypercoagulable states may contribute to coronary renarrowing.
• While thrombin's role in injury-induced restenosis is suggested experimentally, clinical data are limited.

Purpose of the Study:

• To investigate the clinical relevance of hypercoagulable states and thrombin generation in restenosis after PTCA.
• To identify laboratory markers associated with restenosis in patients undergoing elective PTCA.

Main Methods:

• Sixty patients with stable coronary artery disease undergoing successful elective PTCA were assessed.
• Quantitative coronary angiography evaluated restenosis (luminal narrowing >50%) and late luminal loss.
• Laboratory variables including prothrombin fragment 1+2, red blood cell aggregation, and plasminogen-activator inhibitor were measured.

Main Results:

• Prothrombin fragment 1+2 levels were significantly higher in patients with restenosis (1.3+/-0.5 vs. 0.9+/-0.4 mmol/l, p<0.001).
• Red blood cell aggregation and plasminogen-activator inhibitor levels also differed between restenosis and non-restenosis groups (p<0.05).
• Late luminal loss correlated positively with prothrombin fragment 1+2 (r=0.41, p<0.001) and plasmin-alpha2-antiplasmin complex (r=0.39, p<0.01).

Conclusions:

• A hypercoagulable state, particularly involving thrombin generation, is associated with restenosis after PTCA.
• These findings identify a high-risk group prone to coronary renarrowing.
• Clinical data support the role of thrombin generation in restenosis pathogenesis.