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

Rossella Marcucci; Domenico Prisco; Tamara Brunelli; Guglielmina Pepe; Anna Maria Gori; Sandra Fedi; Monia Capanni; Ignazio Simonetti; Giorgio Federici; Anna Pastore; Rosanna Abbate; Gian Franco Gensini

doi:10.1055/s-0037-1613928

Thrombosis and Haemostasis, Table of Contents

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

¹Dip. Medicina Interna, University “Tor Vergata”, Rome

,

Domenico Prisco

¹Dip. Medicina Interna, University “Tor Vergata”, Rome

,

Tamara Brunelli

¹Dip. Medicina Interna, University “Tor Vergata”, Rome

,

Guglielmina Pepe

¹Dip. Medicina Interna, University “Tor Vergata”, Rome

,

Anna Maria Gori

¹Dip. Medicina Interna, University “Tor Vergata”, Rome

,

Sandra Fedi

¹Dip. Medicina Interna, University “Tor Vergata”, Rome

,

Monia Capanni

¹Dip. Medicina Interna, University “Tor Vergata”, Rome

,

Ignazio Simonetti

¹Dip. Medicina Interna, University “Tor Vergata”, Rome

,

Giorgio Federici

¹Dip. Medicina Interna, University “Tor Vergata”, Rome

,

Anna Pastore

²Osp. Pediatrico Bambin Gesù, IRCCS, Rome, Italy

,

Rosanna Abbate

,

Gian Franco Gensini

› Author Affiliations

Abstract

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

Full Text

References

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