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

Background-The fibrinolytic system is intimately involved in several proces ses that contribute to restenosis, including clot dissolution. cell migrati on, and tissue remodeling. However, the role of the individual activators ( urokinase [uPA] and tissue plasminogen [tPA] activators) and inhibitors (pl asminogen activator inhibitor [PAI-1]) of the fibrinolytic system in mainta ining patency after coronary artery angioplasty and stenting is unclear. Methods and Results-We prospectively studied 159 patients with stable angin a who underwent successful elective angioplasty (n=110) or stenting (n=49) of de novo native coronary artery lesions. Plasma samples were drawn at bas eline (before angioplasty) and serially after angioplasty (immediately afte rward 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 PA I-1 Follow-up quantitative coronary angiography was performed in 92% of eli gible 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 a nd PAI-1 antigen levels were significantly lower in patients with restenosi s. Restenosis rates for patients in the upper tertile of baseline uPA antig en levels were 2-fold higher than for those in the lower 2 tertiles (46% ve rsus 24% and 22%, respectively; P<0.004). In a stepwise regression multivar iate analysis, obstruction diameter after the procedure and uPA antigen wer e significant predictors of follow-up diameter stenosis. Conclusions-Plasma uPA antigen levels and PAI-1 antigen levels identify pat ients at increased risk fur restenosis after percutaneous coronary revascul arization.