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Percutaneous interventions alter the hemostatic profile of patients with unstable versus stable angina
S Yazdani1, A D Simon, L Kovar
1Department of Medicine, Columbia-Presbyterian Medical Center, New York 10032, USA.
Insights
Patients with unstable angina exhibit higher levels of tissue-type plasminogen activator (t-PA) and von Willebrand factor (vWF). Percutaneous interventions normalize these hemostatic factors, suggesting plaque stabilization.
Area of Science:
- Cardiology
- Hematology
- Biochemistry
Background:
- Coronary artery disease is linked to hemostatic factor disturbances.
- The specific role in stable versus unstable angina requires further definition.
Purpose of the Study:
- Compare hemostatic profiles in stable vs. unstable angina.
- Assess the impact of percutaneous interventions on these profiles.
Main Methods:
- Studied 61 patients with stable or unstable angina undergoing percutaneous coronary interventions.
- Measured plasma levels of t-PA, PAI-1, and vWF before and 1 month after intervention.
Main Results:
- Unstable angina patients had higher t-PA and vWF levels pre-intervention.
- No significant differences in PAI-1 levels were observed.
- Post-intervention, t-PA and vWF levels normalized, showing no group differences.
Conclusions:
- Elevated t-PA and vWF may indicate plaque instability.
- Post-intervention reduction suggests plaque reendothelialization and stabilization.
Objectives:
The objectives of this study were to define the hemostatic profiles of patients with unstable angina compared with patients with stable angina and to investigate the effect of percutaneous interventions on the follow-up hemostatic profiles of these patients.
Background:
Disturbances in hemostatic factors have been shown to be present in various clinical syndromes involving coronary artery disease. However, their role in stable angina versus unstable angina is less well defined.
Methods:
We studied 61 patients with either stable or unstable angina undergoing percutaneous coronary interventions. Blood samples were drawn immediately before the intervention and at 1-month follow-up. Plasma levels of tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1) and von Willebrand factor (vWF) were measured by enzyme-linked immunosorbent assays.
Results:
Patients with unstable angina had significantly higher t-PA levels (mean [+/-SE] 23.7 +/- 3.4 vs. 14.3 +/- 1.4 ng/ml, respectively, p = 0.02) and vWF antigen concentrations (2,231 +/- 157 vs. 1,792 +/- 108 mU/ml, respectively, p = 0.03) than patients with stable angina. No statistically significant differences were observed in the PAI-1 levels between the two groups (27.9 +/- 5.5 vs. 21.4 +/- 2.5 ng/ml, respectively, p = 0.25). At 1-month follow-up, there were no longer any significant differences in the t-PA or vWF levels between the two groups (15.7 +/- 1.2 vs. 13.6 +/- 0.6 ng/ml, p = 0.13; 1,962 +/- 170 vs. 1,809 +/- 88 mU/ml, p = 0.39, respectively). There were no significant differences between the hemostatic profiles of patients undergoing percutaneous transluminal coronary angioplasty or coronary stenting initially and at 1-month follow-up.
Conclusions:
These data suggest that elevated plasma levels of t-PA and vWF may correlate with instability of atheromatous plaques, and that their decrease after coronary interventions may reflect plaque reendothelialization and stabilization.