Lack of impact of angioplasty on the time course of elevated coagulation and fibrinolysis parameters in unstable angina pectoris

Abstract

Intracoronary thrombus formation is a common finding in patients with unstable angina pectoris. In a prospective study in 21 patients with unstable angina pectoris without acute revascularization and in 14 patients with acute revascularization (PTCA) treatment, we investigated molecular markers of fibrinolysis and coagulation in order to assess whether PTCA influences the alterations of the coagulation and fibrinolysis in unstable angina during mid-term follow-up. Thrombin/antithrombin III (TAT)-complexes as markers of the activated coagulation cascade, plasminogen activator inhibitor-1 (PAI-1), tissue-type plasminogen activator (t-PA) and d-dimer levels as indicators of the fibrinolytic system were measured serially up to 10 days after admission. Furthermore, antithrombin III (AT III) and fibrinogen were determined. Data of the patients with unstable angina pectoris were compared to 12 age-matched healthy control persons. In patients with unstable angina pectoris, marked alterations of molecular markers of fibrinolysis and coagulation were found. T-PA-antigen and PAI-1 were elevated in comparison to the control group. There were no significant differences between the patients with unstable angina pectoris who needed an acute PTCA and those with only medical treatment either at admission or during follow-up. Our data indicate that in the patients with unstable angina pectoris, fibrinolysis and coagulation are disturbed. No significant differences in time course between the patients with and without PTCA treatment are found in this study, indicating that interventional procedures with contrast media application and large intravascular artificial surfaces do not affect the course of the alterations in coagulation and fibrinolysis observed in acute coronary syndromes.