Correlation between coronary morphology and molecular markers of fibrinolysis in unstable angina pectoris

Background: In acute coronary syndromes, marked alterations of coagulation and fibrinolysis have been observed, but no data are available concerning a possible relation to coronary stenosis morphology. Methods: Thirty one pat ients with unstable angina pectoris were included. Culprit stenosis morphol ogy judged. from coronary angiography was graded using the modified ACC/AHA classification. Molecular and functional markers of hemostasis and fibrino lysis were determined from venous plasma samples obtained at admission. Res ults: Patients with unstable angina pectoris had a moderate procoagulant st ate, especially a contact phase activation compared with age-matched contro ls (factor XII 93.9 +/- 5.6 vs 112.8 +/- 5.4%; P < 0.05; high molecular wei ght kininogen 55.3 +/- 5.4 vs 86.1 +/- 6.5%; P < 0.01). Thrombin-antithromb in (TAT) was not significantly elevated (7.6 +/- 1.9 vs 4.0 +/- 0.5 mu g/l) . Elevated plasminogen activator mass concentration (16.6 +/- 2.1 vs 5.4 +/ - 0.6 ng/ml; P < 0.01) and plasminogen activator inhibitor (PAI) activity ( 9.9 +/- 3.0 vs 5.6 +/- 3.0 AU/ml; P < 0.05) indicated an alteration of the fibrinolysis. Complexity of coronary stenosis was positively correlated wit h tissue-type plasminogen activator (TPA) mass concentration (P < 0.01) and PAI activity (P < 0.05). No association was found to markers of a hypercoa gulative state. Conclusion: These findings indicate a relation between alte rations of the fibrinolytic system and coronary morphology, whereas the acu te changes of coagulation occur independently of culprit stenosis complexit y. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.