Impaired Fibrinolysis in Angiographically Documented Coronary Artery Disease

[摘要] Impaired fibrinolysis may predispose to coronary artery disease (CAD). Hypofibrinolysis due to high levelsof plasminogenactivator inhibitor-1 (PAI-1)has beenreported in CAD. A novel regulator of fibrinolytic activity, thrombin activatable fibrinolysis inhibitor (TAFI), has attracted attentioninrecentyears.Itactsbyblockingtheformationofaternary complexof plasminogen,fibrin,and tissueplasminogenactivator(t-PA). Previouslyambiguousresults regarding TAFI levels have been reported in CAD. We measured plasma levels of PAI-1 and TAFI antigenin 123 patients with age ranging from 40 to 65 yearswho had been submitted to coronary angiography and assessed the association of these markers with the extent of stenosis in three groups:angiographicallynormalartery(NAn),mildtomoderateatheromatosis(MA), and severeatheromatosis(SA).Plasma levels of PAI-1 were increased in patients with severe atheromatosis compared to mild/moderate atheromatosis or to normal patients (66.60, 40.50, and 34.90 ng/mL, resp.;P< 0.001). For TAFI no difference was found between different groups. When patients were grouped in only two groups based on clinical cut-off point for intervention (stenosis less than or above 70%) we found increased plasma levels for PAI-1 (37.55 and 66.60 ng/mL, resp.;P< 0.001) and decreased plasma levels for TAFI (5.20 and 4.53 μg/mL, resp.;P= 0.04) in patients with stenosis above 70%. No difference was found in PAI-1 or TAFI levels comparing the number of affected vessels.Conclusion. As evidenced by a raised level of PAI-1 antigen, one can suggestanimpaired fibrinolysis in stable CAD, although no correlation with the number of affected vessels was found. Curiously, a decreased plasma level of total TAFI levels was observed in patients with stenosis above 70%. Further studies measuring functional TAFI are required in order to elucidateits association with the extent of degree of atheromatosis.

[学科分类] 血液学