PLASMA-LEVELS OF TISSUE-PLASMINOGEN ACTIVATOR AND PLASMINOGEN-ACTIVATOR INHIBITOR-1 ARE CORRELATED WITH THE PRESENCE OF TRANSPLANT CORONARY-ARTERY DISEASE IN CARDIAC TRANSPLANT RECIPIENTS

Hemostatic factors are involved in the pathogenesis of native coronary artery disease. However, their role in transplant coronary artery dis ease is less established. To assess the role of hemostatic factors in transplant coronary artery disease we studied 52 consecutive cardiac t ransplant patients. The presence of transplant coronary artery disease was determined by angiography. Plasma levels of tissue plasminogen ac tivator (t-PA), plasminogen activator inhibitor-1 (PAI-I), van Willebr and Factor (VWF), and fibrin D-dimer were determined by enzyme-linked immunosorbent assays. Serum lipids were measured by enzymatic methods. Patients with transplant coronary artery disease had higher circulati ng t-PA (8.6 +/- 0.8 vs. 5.4 +/- 0.6 ng/ml, p = 0.021) and PAI-1 antig en concentrations (38.0 +/- 3.4 vs 25.8 +/- 2.2 ng/ml, p = 0.037). t-P A and PAI-I antigen concentrations correlated with the severity of ang iographic disease (R = 0.34; p = 0.014 for t-PA, and R = 0.45; p = 0.0 01 for PAI-1). Serum cholesterol levels were higher in patients with t ransplant coronary artery disease (221 +/- 7.6 vs 191 +/- 9.2 mg/dl, p = 0.039). Serum triglycerides were also higher in patients with trans plant coronary artery disease by angiography (246 +/- 38.3 vs 139 +/- 20.8 mg/dl, p = 0.050). Multivariate analysis identified t-PA antigen (p = 0.003) and triglyceride levels (p = 0.038) as independent predict ors for the presence of transplant coronary artery disease. We conclud e that cardiac transplant patients with evidence of transplant coronar y artery disease on coronary angiography have altered hemostatic funct ion which is reflected by elevated levels of circulating t-PA and PAI- I antigens. The interaction of the hemostatic system and serum lipids in the development of transplant coronary artery disease warrants furt her study. (C) 1997 by Excerpta Medica, Inc.