Cor Vasa 2002, 43(3):148-151

Tissue factor, tissue factor pathway inhibitor, and soluble P-selectin levels in patients with acute coronary syndromes. A preliminary report

Jan Vojáček^1,*, Martin Malý¹, Vladimír Hraboš¹, Martin Mates¹, Petr Hájek¹, David Horák¹, Václav Durdil¹, Michal Semrád², Jan Kvasnička³, Petr Salaj⁴

¹ Divize kardiologie Interní kliniky a Kardiocentrum dospělých Fakultní nemocnice v Motole a 2. lékařské fakulty Univerzity Karlovy

² Klinika kardiovaskulární chirurgie

³ Oddělení klinické hematologie Všeobecné Fakultní nemocnice a 1. lékařské fakulty Univerzity Karlovy

⁴ Ústav hematologie a krevní transfuze, Praha, Česká republika

Introduction:
Tissue factor (TF) is expressed on monocytes entering the atherosclerotic plaque and is present in large amounts in the atherosclerotic plaque. After plaque rupture, it gets in contact with circulating blood and, when bound to activated factor VII (fVIIa), it triggers the coagulation cascade. The natural inactivator of the TF/fVIIa complex is the complex of tissue factor pathway inhibitor (TFPI) with factor Xa (fXa). Besides, TF becomes expressed on the surface of circulating monocytes as a result of their activation.


Group of patients:
The study was designed to compare the levels of TF, TFPI, soluble P-selectin (sP-s), E-selectin (sE-s), and ICAM-1 (sICAM-1) in patients with acute myocardial infarction (AMI), unstable angina (NA), stable angina (SA), and in a control group of healthy volunteers (C). The levels in blood withdrawn from the coronary sinus (CS) and those in peripheral blood (PB) were additionally compared in UA and SA patients.

Results:
ACS patients were shown to have increased TFPI levels in PB (119.6 ± 86.9 ng/ml in UA, p < 0.05, and 373.3 ± 135.1 ng/ml, p < 0.01, in AMI) compared with SA patients (46,3 ± 37,5 ng/ml) and C (45.1 ± 14.3 ng/ml). Only a non-significant tendency to higher TF levels was seen in the PB of UA and AMI (129.1 ± 30.2 pg/ml in AMI, 130.5 ± 57.8 pg/ml in UA, 120.2 ± 45.1 pg/ml in SA and 124,9 ± 31,8 pg/ml in C), and a non-significant tendency to increased sP-s levels in SA and UA vs C and AMI (157.4 ± 88.4 ng/ml in AMI; 184.2 ± 85.4 ng/ml in UA; 201.6 ± 67.9 ng/ml in UA and 151.4 ± 47.1 ng/ml in C).

Conclusion:
TF is the key agent responsible for triggering thrombotic processes in ACS patients. An important role is played by TF's natural inhibitor, TFPI. The authors noted increased TFPI levels in ACS patients. The issue is likely to draw attention soon considering the potential of therapeutic modulation of these initial and basic processes in coronary thrombosis.

Keywords: Tissue factor; Tissue pathway factor inhibitor; P-selectin; Acute coronary syndrome; Unstable coronary plaque

Published: March 1, 2002  Show citation