Postprocedural PAI-1 activity is a risk marker of subsequent clinical restenosis in patients both with and without stent implantation after elective balloon PTCA.

ABSTRACT

Stent implantation after balloon dilation of coronary arteries has improved clinical prognosis in patients undergoing transluminal coronary angioplasty (PTCA), but late restenosis remains a relevant problem. A previous study has indicated that PAI-1 activity changes immediately after PTCA without stent implantation are predictive of clinical restenosis. The present study was aimed to investigate the early PAI-1 changes and fibrin formation in patients undergoing elective PTCA with stent implantation. PAI-1 activity and D-dimer plasma levels were evaluated in two groups of patients (G1 underwent only elective balloon PTCA and G2 underwent elective PTCA with stent implantation) before and after the procedure. At the end of the procedure, PAI-1 activity significantly decreased, while D-dimer levels significantly increased in both groups. Post-PTCA D-dimer levels in the group with stent implantation were significantly higher than in the other group (P<.05). In both groups of patients, the post-PTCA PAI-1 activity was higher in patients with subsequent clinical recurrence with restenosis (P<.005 in G1 and P<.0005 in G2) than in those without, whereas no differences were found in D-dimer levels. In conclusion, our results demonstrate that fibrin formation assessed by D-dimer levels is enhanced by stent implantation. However, this behaviour is not related, differently from PAI-1 changes, to subsequent occurrence of clinical restenosis.