Document Detail

Impaired myocardial t-PA release in patients with coronary artery disease.
MedLine Citation:
PMID:  19025531     Owner:  NLM     Status:  MEDLINE    
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.
B Osterlund; S Jern; C Jern; H Seeman-Lodding; M Ostman; G Johansson; B Biber
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  52     ISSN:  1399-6576     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-11-25     Completed Date:  2009-01-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  England    
Other Details:
Languages:  eng     Pagination:  1375-84     Citation Subset:  IM    
Surgical and Perioperative Science, Anesthesiology and Intensive Care, Umeå University, Umeå, Sweden.
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MeSH Terms
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
Heart Rate
Middle Aged
Myocardial Ischemia / metabolism*
Plasminogen Activator Inhibitor 1 / blood*
Tissue Plasminogen Activator / blood*
Reg. No./Substance:
0/Plasminogen Activator Inhibitor 1; EC Plasminogen Activator

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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