Assessment of coagulation and platelet activation in coronary sinus blood induced by transcatheter coronary intervention for narrowing of the left anterior descending coronary artery

Influences of recently developed methods for coronary intervention on hemos tasis in the coronary circulation are unclear. The objective of this study was to investigate changes in coagulation and platelet activation in the co ronary circulation induced by percutaneous transluminal coronary angioplast y (PTCA). We studied 35 patients with coronary heart disease who underwent elective PTCA to isolated stenotic narrowing of left coronary arteries. Sev en patients received only PTCA, 12 underwent percutaneous transluminal rota tional atherectomy (PTRA), and 16 underwent stent implantation. Blood sampl es were drawn from the coronary sinus immediately before and after as well as 4 and 24 hours after PTCA. plasma revels of tissue factor (TF), thrombin -antithrombin III complex, plasminogen activator inhibitor (PAI)-1, tissue plasminogen activator (t-PA), beta-thromboglobulin, and platelet factor 4 w ere measured by enzyme-linked immunosorbent assay. In all patients, levels in the coronary sinus blood showed significant increases 4 and 24 hours aft er PTCA and thrombin-antithrombin III complex levels showed significant inc reases 24 hours after PTCA. PAI-I showed significant increases 24 hours aft er PTCA and t-PA showed significant increases 4 and 24 hours after PTCA. Ch anges in levels of these markers by PTCA were similar among the 3 groups. I n PTRA, levels of beta-thromboglobulin and platelet factor 4, markers of pl atelet activation, increased immediately after the procedure and returned t o baseline levels after 4 hours. PTCA induced increases in blood coagulatio n and fibrinolysis in the coronary circulation. PTRA caused a marked but tr ansient activation of platelets. These changes may contribute to acute comp lications during the procedure. (C) 2000 by Excerpta Medica, Inc.