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Mariann Gyngysi, Christoph Strehblow, Wolfgang Sperker, Akos Hevesi, Rita Garamvlgyi, Zsolt Petrsi, Noemi Pavo, Pter Ferdinandy, Csaba Csonka, Tams Csont, Christer Sylvn, Paul J. Declerck, Imre Pavo, Johann Wojta, Dietmar Glogar, Kurt Huber
Platelet activation and high tissue factor level predict acute stent thrombosis in pig coronary arteries: Prothrombogenic response of drug-eluting or bare stent implantation within the first 24 hours
Keywords: platelets, stents,thrombosis, coronary circulation, Tissue factor
Increased thrombogenicity of drug-eluting stents (DESs) has recently been reported. The aim of the present study was to investigate the prothrombogenic effect of DESs and Bare stents, and determine factors predictive of acute stent thrombosis (AST) in preclinical experiments using new stent design or coating. Circulating pre- and post-stenting parameters of platelet activation (mean platelet volume, MPV; platelet distribution width, platelet large cell ratio), thrombin activation (thrombin-antithrombin complex, TAT and prothrombin fragments, F1+2), tissue factor antigen (TF-ag) and -activity (TF-act) and plasminogen activator inhibitor-1 (PAI-1) were measured in 141 consecutive pigs. Stent implantations were performed after pretreatment with aspirin and clopidogrel with unfractionated heparin anticoagulation. Nineteen pigs (groups AST-DES, n = 12; and AST-Bare, n = 7) died mean 6.3 2.9 h after stent implantation from AST. The remaining 122 control (C) pigs (groups C-DES, n = 76, and C-Bare, n = 46) survived the 1-month follow-up. Non-significantly elevated levels of post-stent F1+2 and TAT were measured in AST groups. Post-stenting MPV was increased significantly in the groups ASTDES and AST-Bare as compared with the groups C-DES and C-Bare (11.73 1.12 and 11.6 0.68 vs. 8.85 0.78 and 9.04 0.81 fL; p < 0.001), similarly to TF-ag (189.1 87.5 and 127 34.9 vs. 42.5 24.6 and 35.3 37.6 pg/ml; p < 0.001, respectively), Tfact (3.23 0.95 and 2.73 1.68 vs. 1.43 1.12 and 1.61 1.31 pM; p < 0.01, respectively) and PAI-1 (99.1 15.8 and 99 14.7 vs.53.4 40.2 and 46.9 42.4 ng/ml;p < 0.01, respectively). Multivariate analysis revealed elevated post-stenting plasma levels of TF-ag (p = 0.016) and MPV (p = 0.001) as independent risk factors for developing AST within the first 24 h in a porcine coronary stent model.
Thrombosis and Haemostasis, Schattauer
Print ISSN: 0340-6245
Volume: 96, 08/2006
Pages: 202 - 209