Release of platelet activation markers during coronary angioplasty

Background Authors of several studies have reported that activation of plat elets occurs during coronary angioplasty, but consistent results have not b een obtained. Levels of serotonin in coronary circulation have been found t o be elevated during percutaneous transluminal coronary angioplasty but gre ater than normal concentrations of beta-thromboglobulin and platelet factor 4 have not been detected. Objective To perform a serial analysis of platelet-activation markers with simultaneous measurements of revels of serotonin, beta-thromboglobulin and platelet factor 4 in blood samples from the coronary artery and coronary si nus of patients undergoing coronary angioplasty. Methods Twenty patients undergoing elective coronary angioplasty were studi ed. Measurements of levels of beta-thromboglobulin, platelet factor 4, and serotonin in samples from the ostium of the coronary artery and the coronar y sinus were performed immediately before angioplasty and after the first b alloon deflation. Results Concentrations of beta-thromboglobulin and platelet factor 4 in cor onary artery and coronary sinus were elevated in all patients before dilata tion, whereas concentrations of serotonin were elevated in 85% of the patie nts. Concentrations of all markers in coronary sinus decreased after the fi rst inflation. The coronary-sinus: coronary-artery concentration ratios bef ore dilatation for beta-thromboglobulin, platelet factor 4, and serotonin w ere >1 for the majority of patients, particularly for those with complex cu lprit lesions, indicating that coronary activation of platelets was occurri ng. Ratios remained unchanged or decreased after the first inflation, depen ding on initial values. Conclusions Both systemic and coronary activation occur in patients subject ed to percutaneous transluminal coronary angioplasty before the onset of in tervention. After balloon deflation the greater than normal baseline corona ry-sinus: coronary-artery concentration ratios of ail markers (beta-thrombo globulin, platelet factor 4 and serotonin) tend to decline or remain unchan ged, depending on the level of activation. Coron Artery Dis 11:391-398 (C) 2000 Lippincott Williams & Wilkins.