Effect of invasive therapeutic coronary interventions on endothelial cell activation and thrombin generation in patients with chronic total coronary occlusion

Percutaneous coronary intervention (PCI) is commonly used treatment for chronic total occlusion (CTO). PCI can be performed in two different ways using wire escalation (WE) or subintimal dissection and reentry (DR) technique. During both procedures patients are treated with anticoagulants, however a...

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Bibliographic Details
Published in:	Thrombosis research Vol. 217; pp. 64 - 72
Main Authors:	Illési, Ádám, Debreceni, Ildikó Beke, Fejes, Zsolt, Nagy, Béla, Hodosi, Katalin, Kappelmayer, János, Csanádi, Zoltán, Szük, Tibor István
Format:	Journal Article
Language:	English
Published:	Elsevier Ltd 01-09-2022
Subjects:	Biomarker Chronic total coronary occlusion Coronary intervention Endothelial cell activation Thrombin generation Thrombin generation Coronary intervention Biomarker Endothelial cell activation Chronic total coronary occlusion
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Summary:	Percutaneous coronary intervention (PCI) is commonly used treatment for chronic total occlusion (CTO). PCI can be performed in two different ways using wire escalation (WE) or subintimal dissection and reentry (DR) technique. During both procedures patients are treated with anticoagulants, however a substantial activation of coagulation cascade is expected, which may affect clinical outcome. Our aim was to compare the impact of WE and DR techniques regarding endothelial cell activation and thrombin formation. Fifty patients after CTO-PCI were enrolled into this study. Blood samples were obtained before PCI, at 48 h and 3–6 months after the intervention to measure soluble endothelium-specific markers and to investigate thrombin generation. Twenty-nine patients were treated with WE, 21 received DR. In the DR group, soluble VCAM-1 (vascular cell adhesion molecule-1) and ICAM-1 (intercellular cell adhesion molecule-1) concentrations were gradually elevated and remained significantly increased at 3–6 months (p = 0.006 and p = 0.037, respectively) compared to pre-PCI. Furthermore, significant decrease in lagtime (p = 0.004) and time to peak (p = 0.002) with a substantial increment in peak thrombin (p = 0.001) were observed in these patients. In contrast, no significant alteration was found in the WE cohort. Clinical complications (myocardial infarction, stroke, thrombosis, revascularization) did not occur in the first 9 months of follow-up period in either group. Although DR intervention induces more thrombin generation with a larger degree of endothelium activation compared to WE, this technique does not cause more clinical complications.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0049-3848 1879-2472
DOI:	10.1016/j.thromres.2022.07.010