Postprocedural PAI-1 activity is a risk marker of subsequent clinical restenosis in patients both with and without stent implantation after elective balloon PTCA

Stent implantation after balloon dilation of coronary arteries has improved clinical prognosis in patients undergoing transluminal coronary angioplast y (PTCA), but late restenosis remains a relevant problem. A previous study has indicated that PAI-1 activity changes immediately after PTCA without st ent implantation are predictive of clinical restenosis. The present study w as aimed to investigate the early PAI-1 changes and fibrin formation in pat ients undergoing elective PTCA with stent implantation. PAI-1 activity and D-dimer plasma levels were evaluated in two groups of patients (G1 underwen t only elective balloon PTCA and G2 underwent elective PTCA with stent impl antation) before and after the procedure. At the end of the procedure, PAI- 1 activity significantly decreased, while D-dimer levels significantly incr eased in both groups. Post-PTCA D-dimer levels in the group with stent impl antation were significantly higher than in the other group (P < .05). In bo th groups of patients, the post-PTCA PAI-1 activity was higher in patients with subsequent clinical recurrence with restenosis (P < .005 in G1 and P < .0005 in G2) than in those without, whereas no differences were found in D -dimer levels. In conclusion, our results demonstrate that fibrin formation assessed by D-dimer levels is enhanced by stent implantation. However, thi s behaviour is not related, differently from PAI-1 changes, to subsequent o ccurrence of clinical restenosis. (C) 2001 Elsevier Science Ltd. All rights reserved.