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Thromb Haemost 2000; 83(06): 826-832
DOI: 10.1055/s-0037-1613928
Commentary
Schattauer GmbH

Tissue Factor and Homocysteine Levels in Ischemic Heart Disease Are Associated with Angiographically Documented Clinical Recurrences after Coronary Angioplasty

Rossella Marcucci
1   Dip. Medicina Interna, University “Tor Vergata”, Rome
,
Domenico Prisco
1   Dip. Medicina Interna, University “Tor Vergata”, Rome
,
Tamara Brunelli
1   Dip. Medicina Interna, University “Tor Vergata”, Rome
,
Guglielmina Pepe
1   Dip. Medicina Interna, University “Tor Vergata”, Rome
,
Anna Maria Gori
1   Dip. Medicina Interna, University “Tor Vergata”, Rome
,
Sandra Fedi
1   Dip. Medicina Interna, University “Tor Vergata”, Rome
,
Monia Capanni
1   Dip. Medicina Interna, University “Tor Vergata”, Rome
,
Ignazio Simonetti
1   Dip. Medicina Interna, University “Tor Vergata”, Rome
,
Giorgio Federici
1   Dip. Medicina Interna, University “Tor Vergata”, Rome
,
Anna Pastore
2   Osp. Pediatrico Bambin Gesù, IRCCS, Rome, Italy
,
Rosanna Abbate
,
Gian Franco Gensini
› Author Affiliations
Further Information

Publication History

Received 03 August 1999

Accepted after resubmission 17 February 2000

Publication Date:
14 December 2017 (online)

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Summary

Background In ischemic heart disease (IHD) patients high plasma levels of Tissue Factor (TF), the trigger of coagulation cascade, are present. Homocysteine (Hcy) is a risk factor for coronary artery disease, and several different pathophysiological mechanisms by which Hcy may play a role in thrombus formation have been postulated in “in vitro” studies. We investigated the “in vivo” role of Hcy in affecting plasma levels of TF, its inhibitor Tissue Factor Pathway Inhibitor (TFPI) and hypercoagulability. Methods and Results We investigated 119 IHD patients who underwent PTCA and compared them with 103 healthy subjects. TF, TFPI, Thrombin-Antithrombin complexes (TAT) and Hcy levels were significantly higher in the patients than in the controls. A positive correlation was found between Hcy and TF (r = 0.54; p < 0.0001), Hcy and TFPI (r = 0.26; p < 0.05) as well as Hcy and TAT (r = 0.33; p < 0.0001) levels. An inverse correlation existed between folate intake and Hcy levels (r = −0.28; p = 0.001). Hcy levels within the first quartile and in the highest quartile were associated with a lower (p < 0.001) and higher (p <0.0001) rate of clinical recurrences, respectively. Patients with TF values in the first quartile had a lower rate of angiographically documented clinical recurrences as compared to those in the fourth quartile (p < 0.01); those in the highest quartile of TF showed a higher rate of recurrences (p = 0.001). Multivariate analysis confirmed these results (first quartile of Hcy: OR 0.02, Cl 0.002–0.27; fourth quartile of Hcy: OR 36.5, Cl 3.6-365/first quartile of TF: OR 0.006, Cl 0.001–0.44; fourth quartile of TF: OR 16.4, Cl 3.0 – 90.0), also after adjustment for risk factors and Hcy and TF respectively. Conclusions In this study we show that TF, TFPI and TAT levels are correlated with Hcy plasma levels in IHD patients, providing evidence of an “in vivo” pathophysiological mechanism of hyperhomocysteinemia. The observed association between angiographically documented clinical recurrences and TF and Hcy values awaits confirmation in studies designated to evaluate this issue on a larger number of patients.

Key words

Coronary disease - risk factors - coagulation - angioplasty
 

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