Long-term clinical outcome of acute myocardial infarction according to the early revascularization method: a comparison of primary percutaneous coronary interventions and fibrinolysis followed by routine invasive treatment

민향기,박지영,최재웅,유승기,김성환,송창섭,김동신,송치우,김세종,김영빈 영남대학교 의과대학 2017 Yeungnam University Journal of Medicine Vol.34 No.2

Background: This study was conducted to provide a comparison between the clinical outcomes of primary percutaneous coronary intervention (PCI) and that of fibrinolysis followed by routine invasive treatment in ST elevation myocardial infarction (STEMI). Methods: A total of 184 consecutive STEMI patients who underwent primary PCI or fibrinolysis followed by a routine invasive therapy were enrolled from 2004 to 2011, and their major adverse cardiovascular events (MACEs) were compared. Results: Among the 184 patients, 146 patients received primary PCI and 38 patients received fibrinolysis. The baseline clinical characteristics were similar between both groups, except for triglyceride level (68.1±66.62 vs. 141.6±154.3 mg/dL, p=0.007) and high density lipoprotein level (44.6±10.3 vs. 39.5±8.1 mg/dL, p=0.005). The initial creatine kinase-MB level was higher in the primary PCI group (71.5±114.2 vs. 35.9±59.9 ng/mL, p=0.010). The proportion of pre-thrombolysis in MI 0 to 2 flow lesions (92.9% vs. 73.0%, p<0.001) was higher and glycoprotein IIb/IIIa inhibitors were administered more frequently in the primary PCI group. There was no difference in the 12-month clinical outcomes, including all-cause mortality (9.9% vs. 8.8%, p=0.896), cardiac death (7.8% vs. 5.9%, p=0.845), non-fatal MI (1.4% vs. 2.9%, p=0.539), target lesion revascularization (5.7% vs. 2.9%, p=0.517), and stroke (0% vs. 0%). The MACEs free survival rate was similar for both groups (odds ratio, 0.792; 95% confidence interval, 0.317-1.980; p=0.618). The clinical outcome of thrombolysis was not inferior, even when compared with primary PCI performed within 90 minutes. Conclusion: Early fibrinolysis with optimal antiplatelet and antithrombotic therapy followed by appropriate invasive procedure would be a comparable alternative to treatment of MI, especially in cases of shortersymptom- to-door time

Long-term clinical outcome of acute myocardial infarction according to the early revascularization method: a comparison of primary percutaneous coronary interventions and fibrinolysis followed by routine invasive treatment

( Hyang Ki Min ),( Ji Young Park ),( Jae Woong Choi ),( Sung Kee Ryu ),( Seunghwan Kim ),( Chang Sup Song ),( Dong Shin Kim ),( Chi Woo Song ),( Se Jong Kim ),( Young Bin Kim ) 영남대학교 의과대학 2017 Yeungnam University Journal of Medicine Vol.34 No.2

Background: This study was conducted to provide a comparison between the clinical outcomes of primary percutaneous coronary intervention (PCI) and that of fibrinolysis followed by routine invasive treatment in ST elevation myocardial infarction (STEMI). Methods: A total of 184 consecutive STEMI patients who underwent primary PCI or fibrinolysis followed by a routine invasive therapy were enrolled from 2004 to 2011, and their major adverse cardiovascular events (MACEs) were compared. Results: Among the 184 patients, 146 patients received primary PCI and 38 patients received fibrinolysis. The baseline clinical characteristics were similar between both groups, except for triglyceride level (68.1±66.62 vs. 141.6±154.3 mg/dL, p=0.007) and high density lipoprotein level (44.6±10.3 vs. 39.5±8.1 mg/dL, p=0.005). The initial creatine kinase-MB level was higher in the primary PCI group (71.5±114.2 vs. 35.9±59.9 ng/mL, p=0.010). The proportion of pre-thrombolysis in MI 0 to 2 flow lesions (92.9% vs. 73.0%, p<0.001) was higher and glycoprotein IIb/IIIa inhibitors were administered more frequently in the primary PCI group. There was no difference in the 12-month clinical outcomes, including all-cause mortality (9.9% vs. 8.8%, p=0.896), cardiac death (7.8% vs. 5.9%, p=0.845), non-fatal MI (1.4% vs. 2.9%, p=0.539), target lesion revascularization (5.7% vs. 2.9%, p=0.517), and stroke (0% vs. 0%). The MACEs free survival rate was similar for both groups (odds ratio, 0.792; 95% confidence interval, 0.317-1.980; p=0.618). The clinical outcome of thrombolysis was not inferior, even when compared with primary PCI performed within 90 minutes. Conclusion: Early fibrinolysis with optimal antiplatelet and antithrombotic therapy followed by appropriate invasive procedure would be a comparable alternative to treatment of MI, especially in cases of shorter-symptom- to-door time.

Long-term clinical outcome of acute myocardial infarction according to the early revascularization method: a comparison of primary percutaneous coronary interventions and fibrinolysis followed by routine invasive treatment

Min, Hyang Ki,Park, Ji Young,Choi, Jae Woong,Ryu, Sung Kee,Kim, Seunghwan,Song, Chang Sup,Kim, Dong Shin,Song, Chi Woo,Kim, Se Jong,Kim, Young Bin Yeungnam University College of Medicine 2017 Yeungnam University Journal of Medicine Vol.34 No.2

Background: This study was conducted to provide a comparison between the clinical outcomes of primary percutaneous coronary intervention (PCI) and that of fibrinolysis followed by routine invasive treatment in ST elevation myocardial infarction (STEMI). Methods: A total of 184 consecutive STEMI patients who underwent primary PCI or fibrinolysis followed by a routine invasive therapy were enrolled from 2004 to 2011, and their major adverse cardiovascular events (MACEs) were compared. Results: Among the 184 patients, 146 patients received primary PCI and 38 patients received fibrinolysis. The baseline clinical characteristics were similar between both groups, except for triglyceride level ($68.1{\pm}66.62$ vs. $141.6{\pm}154.3mg/dL$, p=0.007) and high density lipoprotein level ($44.6{\pm}10.3$ vs. $39.5{\pm}8.1mg/dL$, p=0.005). The initial creatine kinase-MB level was higher in the primary PCI group ($71.5{\pm}114.2$ vs. $35.9{\pm}59.9ng/mL$, p=0.010). The proportion of pre-thrombolysis in MI 0 to 2 flow lesions (92.9% vs. 73.0%, p<0.001) was higher and glycoprotein IIb/IIIa inhibitors were administered more frequently in the primary PCI group. There was no difference in the 12-month clinical outcomes, including all-cause mortality (9.9% vs. 8.8%, p=0.896), cardiac death (7.8% vs. 5.9%, p=0.845), non-fatal MI (1.4% vs. 2.9%, p=0.539), target lesion revascularization (5.7% vs. 2.9%, p=0.517), and stroke (0% vs. 0%). The MACEs free survival rate was similar for both groups (odds ratio, 0.792; 95% confidence interval, 0.317-1.980; p=0.618). The clinical outcome of thrombolysis was not inferior, even when compared with primary PCI performed within 90 minutes. Conclusion: Early fibrinolysis with optimal antiplatelet and antithrombotic therapy followed by appropriate invasive procedure would be a comparable alternative to treatment of MI, especially in cases of shorter-symptom-to-door time.

Alternative Mechanism of Aspirin in Anti-Thrombotic Therapy: Inhibition of Thrombin Activatable Fibrinolysis Inhibitor

안성수,Robert S. Greenfield 대한화학회 2012 Bulletin of the Korean Chemical Society Vol.33 No.9

The use of aspirin is widely recommended for the prevention of heart attacks owing to its ability to inhibit platelet activation by irreversibly blocking cyclooxygenase 1. However, aspirin also affects the fibrinolytic and hemostatic pathways by mechanisms that are not well understood, causing severe hemorrhagic complications. Here, we investigated the ability of aspirin and aspirin metabolites to inhibit thrombin-activatable fibrinolysis inhibitor (TAFI), the major inhibitor of plasma fibrinolysis. TAFI is activated via proteolytic cleavage by the thrombin-thrombomodulin complex to TAFIa, a carboxypeptidase B-like enzyme. TAFIa modulates fibrinolysis by removing the C-terminal arginine and lysine residues from partially degraded fibrin, which in turn inhibits the binding of plasminogen to fibrin clots. Aspirin and its major metabolites, salicylic acid, gentisic acid, and salicyluric acid, inhibit TAFIa carboxypeptidase activity. Salicyluric acid effectively blocks activation of TAFI by thrombin-thrombomodulin; however, salicylates do not inhibit carboxypeptidase N or pancreatic carboxypeptidase B. Aspirin and other salicylates accelerated the dissolution of fibrin clots and reduced thrombus formation in an in vitro model of fibrinolysis. Inhibition of TAFI represents a novel hemostatic mechanism that contributes to aspirin’s therapy-associated antithrombotic activity and hemorrhagic complications.

Alternative Mechanism of Aspirin in Anti-Thrombotic Therapy: Inhibition of Thrombin Activatable Fibrinolysis Inhibitor

An, Seong-Soo A.,Greenfield, Robert S. Korean Chemical Society 2012 Bulletin of the Korean Chemical Society Vol.33 No.9

The use of aspirin is widely recommended for the prevention of heart attacks owing to its ability to inhibit platelet activation by irreversibly blocking cyclooxygenase 1. However, aspirin also affects the fibrinolytic and hemostatic pathways by mechanisms that are not well understood, causing severe hemorrhagic complications. Here, we investigated the ability of aspirin and aspirin metabolites to inhibit thrombin-activatable fibrinolysis inhibitor (TAFI), the major inhibitor of plasma fibrinolysis. TAFI is activated via proteolytic cleavage by the thrombin-thrombomodulin complex to TAFIa, a carboxypeptidase B-like enzyme. TAFIa modulates fibrinolysis by removing the C-terminal arginine and lysine residues from partially degraded fibrin, which in turn inhibits the binding of plasminogen to fibrin clots. Aspirin and its major metabolites, salicylic acid, gentisic acid, and salicyluric acid, inhibit TAFIa carboxypeptidase activity. Salicyluric acid effectively blocks activation of TAFI by thrombin-thrombomodulin; however, salicylates do not inhibit carboxypeptidase N or pancreatic carboxypeptidase B. Aspirin and other salicylates accelerated the dissolution of fibrin clots and reduced thrombus formation in an in vitro model of fibrinolysis. Inhibition of TAFI represents a novel hemostatic mechanism that contributes to aspirin's therapy-associated antithrombotic activity and hemorrhagic complications.

활차 운동이 인체의 섬유소 용해능에 미치는 영향

김순길,신승호,양동호,김선주,홍세용 대한내과학회 1992 대한내과학회지 Vol.42 No.2

저자들은 섬유소 용해능 자극 검사로서 활차운동의 유용성을 조사하기 위하여 일차적으로 활차운동 후 혈액의 섬유소 용해능의 변화를 조사하였다. 15세에서 68세 사이의 건강한 남자 16명의 활차운동 전후의 euglobulin 섬유소 용해능 및 tissue-type plasminogen activator 와 urokinase-type plasminogen activator의 antigen 농도를 측정하여 다음과 같은 결과를 얻었기에 보고하는 바이다. 1) Euglobulin 섬유소 용해능은 활차운동 전 98.4±9.5 BAU (Blood Activator Unit)에서 운동 후 116.4±17.4 BAU로 증가하였다(p<0.0005). 2) t-PA antigen 농도는 활차운동전 3.2±2.3ng/㎖에서 운동후 4.9±2.6ng/㎖로 증가하였다(p<0.0001). 3) u-PA antigen 농도는 활차운동전 1.7±0.3ng/㎖에서 운동후 1.7±0.4ng/㎖로 의미있는 변화는 없었다. 결론적으로 활차운동 후 혈장 섬유소 용해능과 t-PA antigen 농도는 현저히 증가하였으며, 전신적인 섬유소 용해능을 자극하는 임상적인 방법으로서 활차운동은 비교적 안전하고 유용한 검사하고 사료된다. The systemic fibrinolytic potential could not be deter-mined by simple measurement of plasma fibrinolytic activity or plasma plasminogen activators, and stimulation test is essential to determine systemic fibrinolytic potential. In general plasma fibrinolytic activity is increased by emotional stress, physical exercise, venous occlusion, and DDAVP (desamino-d-arginine vasopressin) infusion. But until recently standardized test to stimulate systemic fibrinolysis is not established in clinical field. The treadmill exercise is one of the method to stimulate systemic fibrinolysis and is relatively safe in every clinical situations> Moreover standardization of exercise test as clinical standardized stimulation test of systemic fibrinolysis. On the first step, we measured plasma fibrinolytic activities before and after standardized treadmill exdrcise in normal individuals to testify its reliability. Sixteen healthy men (age from 15 to 68) performed more than 85% of maximal exercise determined by heart rate for their age group on treadmill. Before and after exercise we measured euglobulin fibrin lysis area, and antigen levels of t-PA and u-PA by ELISA method. After exercise euglobulin fibrin plate lysis area was increased from 98.4±9.5 BAU (Blood Activator Unit) to 116.4±17.4 (p<0.0005) (Normal pooled plasma: 100 BAU). And t-PA antigen level was also increased from 3.2±2.3ng/㎖ (before exercise) to 4.9±2.6ng/㎖ (after exercise) (p<0.0001). The antigen level of u-PA was not changed after exercise: from 1.7±0.3ng/㎖ pre-exercise to 1.7±0.4ng/㎖ post-exercise. In conclusion we found that systemic fibrinolytic activity and antigen level of t-PA were enhanced after exercise. And we consider that standardized treadmill exercise is safe and reliable method to stimulate systemic fibrinolysis.

Effects of 17β-Estradiol on the Plasminogen Activator System in Vascular Smooth Muscle Cells Treated with Lysophophatidylcholine

Byung-Koo Yoon,Young-Hee Kang,오원종,이동윤,Duk-Kyung Kim,Bruce Kessel,강치덕 대한폐경학회 2020 대한폐경학회지 Vol.26 No.1

Objectives: When administered soon after menopause, hormone therapy can prevent coronary heart diseases in women. To explore the mechanism underlying the cardioprotective actions of estrogen, we investigated the effects of 17β-estradiol (17β-E2) on the plasminogen activator system using cultured vascular smooth muscle cells (VSMCs). Methods: VSMCs were isolated from rat aortas. Protein expression of plasminogen activator inhibitor type 1 (PAI-1) and tissue-type plasminogen activator (t-PA) were evaluated using Western blotting and enzyme-linked immunosorbent assay, respectively. The enzyme activity of PAI-1 in a conditioned medium was assessed via reverse fibrin overlay zymography and that of t-PA was assessed via fibrin overlay zymography. Gene expression was quantified using real-time reverse transcription-polymerase chain reaction. Results: Following pre-treatment for 24 hours, 17β-E2 suppressed both protein expression and enzyme activity of PAI-1 stimulated by lysophosphatidylcholine (lysoPC) in a significant and dose-dependent manner at a near physiological concentration. Moreover, 17β-E2 (10−7 M) inhibited PAI-1 gene expression, and ICI 182,780—a specific estrogen receptor antagonist—blocked the effects of 17β-E2 on the PAI-1 protein. 17β-E2 did not affect t-PA secretion but significantly enhanced free t-PA activity through reduced binding to PAI-1. Furthermore, 17β-E2 suppressed intracellular reactive oxygen species production and nuclear factor-κB-mediated transcription. Conclusions: In VSMCs stimulated with lysoPC, 17β-E2 reduced PAI-1 expression through a non-receptor-mediated mechanism via antioxidant activity as well as a receptor-mediated mechanism; however, it did not alter t-PA secretion. Of note, 17β-E2 suppressed PAI- 1 activity and concurrently enhanced t-PA activity, suggesting a beneficial influence on fibrinolysis.

혈액응고 및 섬유소용해에 대한 Propofol 마취의 효과-뇌동맥류 결찰 시 혈전탄성묘사기에 의한 평가

김영재,송동현,김정훈,정순호,최영균,박진우,신치만,박주열 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.1

백혈병세포 아형에 따른 uPA 수용체 발현양상과 출혈성 지표에 대한 인자 분석

남정현,송경순,이정운,권오헌,한지숙 한국지혈혈전학회 1996 한국지혈혈전학회지 Vol.3 No.1

Clot Waveform Analysis for Hemostatic Abnormalities

Wada Hideo,Shiraki Katsuya,Matsumoto Takeshi,Shimpo Hideto,Shimaoka Motomu 대한진단검사의학회 2023 Annals of Laboratory Medicine Vol.43 No.6

Clot waveform analysis (CWA) observes changes in transparency in a plasma sample based on clotting tests such as activated partial thromboplastin time (APTT), prothrombin time (PT), and thrombin time (TT). Evidence indicates that not only an abnormal waveform but also peak times and heights in derivative curves of CWA are useful for the evaluation of hemostatic abnormalities. Modified CWA, including the PT with APTT reagent, dilute PT (small amount of tissue factor [TF]-induced clotting factor IX [FIX] activation; sTF/FIXa), and dilute TT, has been proposed to evaluate physiological or pathological hemostasis. We review routine and modified CWA and their clinical applications. In CWA-sTF/FIXa, elevated peak heights indicate hypercoagulability in patients with cancer or thrombosis, whereas prolonged peak times indicate hypocoagulability in several conditions, including clotting factor deficiency and thrombocytopenia. CWA-dilute TT reflects the thrombin burst, whereas clot-fibrinolysis waveform analysis reflects both hemostasis and fibrinolysis. The relevance and usefulness of CWA-APTT and modified CWA should be further investigated in various diseases.