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(Circulation. 2003;108:2864.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Involvement of Tissue Factor Pathway Inhibitor in the Coronary Circulation of Patients With Acute Coronary Syndromes

Paolo Golino, MD, PhD; Amelia Ravera, MD; Massimo Ragni, MD, PhD; Plinio Cirillo, MD, PhD; Orlando Piro, MD; Massimo Chiariello, MD

From the Department of Internal Medicine and Cardiovascular Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy. Dr Golino is currently at the Division of Cardiology, Second University of Naples, Italy.

Correspondence to Paolo Golino, MD, PhD, Division of Cardiology, Second University of Naples, Piazza Luigi Miraglia, 2, 80123 Naples, Italy. E-mail paolo.golino{at}unina2.it

Received February 18, 2003; de novo received July 3, 2003; revision received September 11, 2003; accepted September 12, 2003.

Background— Tissue factor pathway inhibitor (TFPI) is the endogenous inhibitor of the extrinsic coagulation pathway; however, its involvement during thrombus formation in patients with acute coronary syndromes (ACS) is still unknown.

Methods and Results— Transcardiac (aorta/coronary sinus) free and total TFPI (free + lipoprotein-bound form) levels, as well as TFPI/factor Xa (FXa) complex levels, were measured in plasma samples obtained from patients with acute myocardial infarction undergoing primary PTCA and patients with unstable angina undergoing urgent PTCA. Patients with stable angina undergoing elective PTCA served as controls. In addition, prothrombin fragment 1+2 and fibrinopeptide A plasma levels were measured. Samples were collected at baseline, after PTCA, and after stent deployment. In patients with ACS, both total and free TFPI plasma levels in the coronary sinus were significantly lower than the corresponding levels measured in the aorta at any time point of the study; conversely, a significant increase in TFPI/FXa complex plasma levels was observed in the coronary sinus as compared with the aorta. In contrast, in patients with stable angina, no differences were observed in TFPI and TFPI/FXa levels at baseline in the coronary sinus as compared with the aorta.

Conclusions— TFPI is involved in the process of thrombus formation in vivo in patients with ACS, which suggests a potential role for TFPI in modulating coronary thrombosis.

Key Words: inhibitors, tissue factor pathway • tissue factor • acute coronary syndromes

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