Postangioplasty restenosis: platelet activation and the coagulation-fibrinolysis system as possible factors in the pathogenesis of restenosis.

We investigated the relationship between changes in hemostatic factors and postangioplasty restenosis by evaluating plasma levels of P-selectin, beta-thromboglobulin (BTG), and other markers of the coagulation-fibrinolysis system. Seventy-three consecutive patients (56 men and 17 women) undergoing elective percutaneous transluminal coronary angioplasty (PTCA) were enrolled in this study. Patients with acute myocardial infarction within the previous month, unstable angina pectoris, chronic total occlusion, target lesions involving saphenous vein grafts, or coronary artery bypass grafting within the previous 6 months were excluded. Fasting blood samples were obtained before elective PTCA and at follow-up coronary angiography. In patients with restenosis, plasminogen activator inhibitor type-1 (PAI-1) levels were significantly higher (88.2 +/- 36.1 vs 118.5 +/- 50.0 ng/dl; p< 0.05) and plasmin-plasmin inhibitor complex (PIC) levels were significantly lower (0.76 +/- 0.26 vs 0.61 +/- 0.26 microg/ml; p < 0.02) than at baseline. P-Selectin levels were also significantly higher (192 +/- 68 vs 239 +/- 99 ng/ dl; p<0.01) and a positive correlation existed between P-selectin and BTG levels (r= 0.43; p< 0.05). The higher PAI-1 and lower PIC levels in patients with postangioplasty restenosis suggest that impaired fibrinolysis may play a role in the pathogenesis of restenosis, whereas the positive correlation between P-selectin and BTG levels implies a role for activated platelets in restenosis.