Plasma urokinase antigen and plasminogen activator inhibitor-1 antigen levels predict angiographic coronary restenosis

被引:83
作者
Strauss, BH
Lau, HK
Bowman, KA
Sparkes, J
Chisholm, RJ
Garvey, MB
Fenkell, LL
Natarajan, MK
Singh, I
Teitel, JM
机构
[1] Univ Toronto, St Michaels Hosp, Div Cardiol, Toronto, ON M5B 1W8, Canada
[2] Univ Toronto, St Michaels Hosp, Terrence Donnelly Heart Ctr, Toronto, ON M5B 1W8, Canada
[3] Univ Toronto, St Michaels Hosp, Div Hematol & Oncol, Toronto, ON M5B 1W8, Canada
关键词
angioplasty; restenosis; fibrinolysis; urokinase;
D O I
10.1161/01.CIR.100.15.1616
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-The fibrinolytic system is intimately involved in several processes that contribute to restenosis, including clot dissolution. cell migration, and tissue remodeling. However, the role of the individual activators (urokinase [uPA] and tissue plasminogen [tPA] activators) and inhibitors (plasminogen activator inhibitor [PAI-1]) of the fibrinolytic system in maintaining patency after coronary artery angioplasty and stenting is unclear. Methods and Results-We prospectively studied 159 patients with stable angina who underwent successful elective angioplasty (n=110) or stenting (n=49) of de novo native coronary artery lesions. Plasma samples were drawn at baseline (before angioplasty) and serially after angioplasty (immediately afterward and 6 hours, 24 hours, 3 days, 7 days, month. 3 months. and 6 months afterward). Antigen and activity assays were performed for uPA, tPA, and PAI-1 Follow-up quantitative coronary angiography was performed in 92% of eligible patients Thr overall angiographic restenosis rate (diameter stenosis >50%) was 31% (37% in PTCA patients, 17% in stented patients). At all time periods, including baseline, uPA antigen levels were significantly higher and PAI-1 antigen levels were significantly lower in patients with restenosis. Restenosis rates for patients in the upper tertile of baseline uPA antigen levels were 2-fold higher than for those in the lower 2 tertiles (46% versus 24% and 22%, respectively; P<0.004). In a stepwise regression multivariate analysis, obstruction diameter after the procedure and uPA antigen were significant predictors of follow-up diameter stenosis. Conclusions-Plasma uPA antigen levels and PAI-1 antigen levels identify patients at increased risk fur restenosis after percutaneous coronary revascularization.
引用
收藏
页码:1616 / 1622
页数:7
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