Abstract 3040: Plasminogen Activator Inhibitor-1 Plasma Levels are associated with Coronary Instent Restenosis of Drug-Eluting Stents
BACKGROUND. Percutaneous coronary intervention (PCI) represents the most important treatment modality of coronary artery stenosis today. Although with the introduction of drug eluting stents (DES) in-stent restenosis (ISR) could be reduced dramatically, it still plays a significant role in the long-term outcome after PCI. The fibrinolytic system is believed to be of pathophysiological relevance in the development of ISR.
METHODS. We studied 75 patients (median age 64, 56 male). Blood samples were taken directly before and 24 hours after PCI with DES implantation. Restenosis was evaluated at 6 to 8 months by coronary angiography.
RESULTS. During the follow up period, 2 patients (2,7%) died of cardiovascular causes and ISR was detected in 12 patients (16%). At baseline, patients with ISR at follow-up angiography showed significantly lower plasma levels of PAI-1 active antigen compared to patients without ISR (11.7±8.1 vs.22.8±18.8; p<0.05). Patients with PAI-1 active antigen in the lowest tertile showed a 9.5-fold risk of ISR compared to patients in the third tertile (p<0.05). The PCI-induced change of PAI-1 active antigen was significantly higher in patients with ISR as compared to patients without ISR (+5.6±8.0 ng/mL vs −3.2±12.1 ng/mL; p<0.05). Multiple regression analysis revealed that late lumen loss was associated with the PCI-induced change of PAI-1 active antigen and inversely correlated with PAI-1 active antigen before PCI independent from stent diameter, stent length, type of stent, number of stents, stented vessel as well as presence of diabetes.
CONCLUSION. The occurrence of ISR showed a significant correlation with baseline plasma levels of PAI-1 active antigen before PCI and the change of PAI-1 active antigen due to PCI. As PAI-1 may play a role in the pathogenesis of ISR, determination of PAI-1 plasma levels might be helpful in the identification of patients with high risk for development of IRS after DES implantation.