加速纤溶酶原激活物抑制剂可能预防急性心肌梗死冠状动脉支架置入术后的晚期再狭窄。

Accelerated plasminogen activator inhibitor may prevent late restenosis after coronary stenting in acute myocardial infarction.

作者信息

Inoue Teruo, Yaguchi Isao, Mizoguchi Keiichi, Uchida Toshihiko, Takayanagi Kan, Hayashi Terumi, Morooka Shigenori, Eguchi Yutaka

机构信息

Department of Cardiology, Koshigaya Hospital, Dokkyo University School of Medicine, Koshigaya-City, Saitama, Japan.

出版信息

Clin Cardiol. 2003 Mar;26(3):153-7. doi: 10.1002/clc.4960260311.

DOI:10.1002/clc.4960260311

PMID:12685623

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6654356/

Abstract

BACKGROUND

Although acceleration of plasma plasminogen activator inhibitor-1 (PA-1) level after emergent coronary angioplasty in acute myocardial infarction (AMI) has been documented, its pathophysiologic role is still unknown.

HYPOTHESIS

This study was designed to elucidate the role of PAI-1 in the development of restenosis after primary coronary stenting in AMI.

METHODS

We selected for this study 66 patients with AMI, who underwent primary coronary stenting for infarct-related coronary artery lesions in an emergent situation. In all patients, plasma PAI-1 level was measured at admission, and at 3 h, 24 h, 48 h, and 1 month after coronary stenting.

RESULTS

At admission, the PAI-1 level was equivalent in 24 patients who experienced restenosis and in 42 patients without restenosis (28 +/- 4 vs. 29 +/- 4 ng/ml). In patients with restenosis, the levels did not change during the course after coronary stenting. In patients without restenosis, however, the level significantly increased at 3 h (48 +/- 9 ng/ml, p < 0.001), 24 h (42 +/- 9, p < 0.01), and 48 h (38 +/- 7, p < 0.05) after coronary stenting, and was restored to the level equivalent to that at admission (27 +/- 2 ng/ml) I month aftercoronary stenting. The PA-1 level at 3 h after coronary stenting in patients without restenosis was significantly higher (p < 0.05) than the level (33 +/- 6 ng/ml) in patients with restenosis. Multiple logistic regression analysis indicated that the PAI-1 level 3 h after coronary stenting was an independent predictor of restenosis (Wald chi2 = 3.826, p = 0.019, odds ratio 0.921, 95% confidence interval 0.866-0.961).

CONCLUSION

Accelerated PAI-1 after coronary stenting in patients with AMI may protect against the development of late restenosis.

摘要

背景

尽管已有文献记载急性心肌梗死（AMI）患者急诊冠状动脉血管成形术后血浆纤溶酶原激活物抑制剂-1（PAI-1）水平会升高，但其病理生理作用仍不清楚。

假说

本研究旨在阐明PAI-1在AMI患者原发性冠状动脉支架置入术后再狭窄发生过程中的作用。

方法

我们选取了66例AMI患者，这些患者在紧急情况下对梗死相关冠状动脉病变进行了原发性冠状动脉支架置入术。对所有患者在入院时以及冠状动脉支架置入术后3小时、24小时、48小时和1个月时测定血浆PAI-1水平。

结果

入院时，24例发生再狭窄的患者与42例未发生再狭窄的患者的PAI-1水平相当（28±4对29±4 ng/ml）。发生再狭窄的患者在冠状动脉支架置入术后病程中PAI-1水平未发生变化。然而，未发生再狭窄的患者在冠状动脉支架置入术后3小时（48±9 ng/ml，p<0.001）、24小时（42±9，p<0.01）和48小时（38±7，p<0.05）时PAI-1水平显著升高，并在冠状动脉支架置入术后1个月恢复到与入院时相当的水平（27±2 ng/ml）。未发生再狭窄的患者冠状动脉支架置入术后3小时的PAI-1水平显著高于发生再狭窄患者的水平（33±6 ng/ml，p<0.05）。多因素logistic回归分析表明，冠状动脉支架置入术后3小时的PAI-1水平是再狭窄的独立预测因素（Waldχ2 = 3.826，p = 0.019，比值比0.921，95%置信区间0.866 - 0.961）。