Impaired myocardial t-PA release in patients with coronary artery disease
2008 (English)In: Acta Anaesthesiol Scand, Vol. 52, no 10, 1375-84 p.Article in journal (Refereed) Published
AIMS: Myocardial ischemia remains a significant perioperative complication in coronary artery disease (CAD) patients. We hypothesized that noxious stimuli during major surgery are associated with an acute release of tissue-type plasminogen activator (t-PA) into the coronary circulation, and that this response is reduced by CAD. METHODS AND RESULTS: Two patient groups, with (n=14) and without (n=8) CAD, were studied during the initial phase of heart surgery. After retrograde great cardiac vein catheterizations during closed-chest conditions, coronary arterial-venous concentration gradients of t-PA and plasminogen activator inhibitor type-1 (PAI-1) were measured together with coronary blood flow measurements, allowing derivation of coronary net release rates. Pre-surgery atrial pacing, performed to evaluate the influence of increases in heart rate (+ 40 beats/min) and coronary blood flow (+ 80 ml/min), did not significantly alter coronary net release of t-PA or PAI-1 in either patient group. Sternotomy induced a prominent increase in coronary net release of both total and active t-PA in the non-CAD group. This response was considerably reduced in the CAD group. CONCLUSIONS: This study provides the first analysis of coronary t-PA release during major surgery and demonstrates a deficient local endothelial t-PA release in patients with CAD. This suggests a reduced local fibrinolytic capacity in CAD patients, which may explain the increased risk for coronary thrombosis in this patient group.
Place, publisher, year, edition, pages
2008. Vol. 52, no 10, 1375-84 p.
Aged, Blood Pressure, Cardiac Pacing, Artificial/methods, Cardiac Surgical Procedures/methods, Catheterization, Swan-Ganz, Coronary Artery Disease/*metabolism, Coronary Thrombosis/prevention & control, Coronary Vessels/metabolism, Endothelium, Vascular/secretion, Female, Heart Rate, Humans, Male, Middle Aged, Myocardial Ischemia/*metabolism, Plasminogen Activator Inhibitor 1/*blood, Tissue Plasminogen Activator/*blood
IdentifiersURN: urn:nbn:se:umu:diva-31393ISBN: 1399-6576 (Electronic)OAI: oai:DiVA.org:umu-31393DiVA: diva2:292939
Osterlund, B Jern, S Jern, C Seeman-Lodding, H Ostman, M Johansson, G Biber, B Research Support, Non-U.S. Gov't England Acta anaesthesiologica Scandinavica Acta Anaesthesiol Scand. 2008 Nov;52(10):1375-84.2010-02-102010-02-102015-09-15