The Relationship Between The Level Of Serum PAI-1 And The Development Of Collaterals In Patients With Coronary Artery Disease

Background and Objective:Development of coronary collateral circulation is an important adaptive mechanism occurring in patients with occlusive coronary artery disease. Well-developed coronary collaterals reduce the size of myocardial infarction, preserve left ventricular function and viability, and reduce the risk of death. Therefore, to enhance the development of coronary collateral circulation might be a new treatment for patient with coronary heart desease. Researches indicated that plasminogen activator inhibitor-1 (PAI-1) induced atherosclerosis through the mechanism of impairing vascular endothelial cell directly or indirectly, inducing endothelial dysfunction and enhancing the proliferation of smooth muscle cell. Endothelial function played a key role in angiogenesis and arteriogenesis, thus we presumed that PAI-1 might associated with the development of coronary collateral circulation. This study was to investigate the relationship between the level of serum PAI-1 and the development of collaterals in patients with severe coronary artery stenosis.Methods:Between September 2009 and January 2010,74 patients who present at least one of a major coronary vessel stenosis more than 90 percent at diagnostic angiography were enrolled in xiangya hospital. Collateral development was graded with validated Rentrop's method, and patients were divided into 4 groups:CCC0 (n=17), CCC1 (n=31), CCC2 (n=16), CCC3 (n=10). The levels of serum PAI-1 were measured by ELISA.Results:(1) The levels of PAI-1 in CCC 0 (29.82±7.51 ng/ml) and CCC 1 (28.68±6.625ng/ml) were significantly higher than that in CCC 2 (24.25±5.183ng/ml) and CCC 3 (18.7±5.012ng/ml) among the patients with severe coronary artery stenosis (P<0.05). (2) After adjusting for age, gender, smoking, diabetes, hyperlipidemia, hypertension, number of diseased vessels and drug utilization, a significant and negtive correlation was observed between PAI-1 and the collateral circulation grade (r =-0.513, P=0.000). (3) Binary logistic regression analysis revealed that PAI-1 was identified as a risk factor of the development of coronary collaterals circulation (b=-1.889,OR=0.151,95%CI 0.035 - 0.652), whereas sub-total occlusion/total occlusion was a protactant factor (b=2.445,OR=11.591,95%CI为1.716-78.278).Conclusions:The levels of serum PAI-1 in the group with poorly developed collaterals were significantly higher than that in the group with well-developed collaterals among the patients with severe coronary artery desease. PAI-1 might be a risk factor of the development of coronary collateral circulation.