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Difference in fibrinolytic activity between multivessel coronary spasm and one-vessel coronary spasm

      There is now increasing evidence that coronary spasm is implicated in the pathogenesis of not only variant angina, but also unstable angina and acute myocardial infarction.
      • Yasue H
      • Omote S
      • Takizawa A
      • Nagano M
      Coronary arterial spasm in ischemic heart disease and its pathogenesis.
      Coronary thrombosis plays an important role in the production of unstable angina or acute myocardial infarction.
      • Roberts W.C
      • Jones A.A
      Quantification of coronary arterial narrowing at necropsy in acute transmural infarction analysis and comparison of findings in 27 patients and 22 controls.
      However, the precise mechanisms by which coronary spasm leads to coronary thrombosis and unstable angina or acute myocardial infarction remain unknown. We have reported that the plasma levels of fibrinopeptide A,
      • Ogawa H
      • Yasue H
      • Oshima S
      • Okumura K
      • Matsuyama K
      • Obata K
      Circadian variation of plasma fibrinopeptide A level in patients with variant angina.
      a sensitive marker of thrombin generation, and plasminogen activator inhibitor (PAI) activity,
      • Masuda T
      • Yasue H
      • Ogawa H
      • Misumi I
      • Sakamoto T
      • Okubo H
      • Miyao Y
      • Kato H
      Plasma plasminogen activator inhibitor activity and tissue plasminogen activator levels in patients with unstable angina and those with coronary spastic angina.
      ,
      • Masuda T
      • Ogawa H
      • Miyao Y
      • Yu Q
      • Misumi I
      • Sakamoto T
      • Okubo H
      • Okumura K
      • Yasue H
      Circadian variation in fibrinolytic activity in patients with variant angina.
      an indicator of the impairment of fibrinolysis, increased in patients with coronary spastic angina. In general, turnover of thrombus depends not only on formation, but also on lysis. The key components of the fibrinolytic system are tissue-type plasminogen activator (t-PA) and PAI. Fibrinolytic activity reflects the balance between t-PA and PAI, and PAI is a major factor in determining overall fibrinolytic activity.
      • Loskutoff D.J
      • Sawdey M
      • Mimuro J
      Type 1 plasminogen activator inhibitor.
      On the other hand, we
      • Yasue H
      • Takizawa A
      • Nagao M
      • Nishida S
      • Horie M
      • Kubota J
      • Omote S
      • Takaoka K
      • Okumura K
      Long-term prognosis for patients with variant angina and influential factors.
      and other researchers
      • Dunn R.F
      • Kelly D.T
      • Sadick N
      • Uren R
      Multivessel coronary artery spasm.
      ,
      • Onaka H
      • Hirota Y
      • Shimada S
      • Kita Y
      • Sakai Y
      • Kawakami Y
      • Suzuki S
      • Kawamura K
      Clinical observation of spontaneous anginal attacks and multivessel spasm in variant angina pectoris with normal coronary arteries evaluation by 24-hour 12-lead electrocardiography with computer analysis.
      have clarified the following facts: (1) Coronary spasm occurs not only at 1 major coronary artery (1-vessel coronary spasm), but also at 2 or 3 major coronary arteries (multivessel coronary spasm). (2) Patients with multivessel spasm have more severe and more prolonged ischemic attacks than those with 1-vessel spasm. (3) In long-term prognosis, the occurrence of cardiac events is higher in patients with multivessel spasm than in those with 1-vessel spasm. In the present study we measured plasma levels of PAI activity and t-PA antigen in patients with coronary spastic angina to compare the differences between the presence of multivessel spasm or 1-vessel spasm and fibrinolytic function.
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      References

        • Yasue H
        • Omote S
        • Takizawa A
        • Nagano M
        Coronary arterial spasm in ischemic heart disease and its pathogenesis.
        Circ Res. 1983; 52: 147-152
        • Roberts W.C
        • Jones A.A
        Quantification of coronary arterial narrowing at necropsy in acute transmural infarction.
        Circulation. 1980; 61: 786-790
        • Ogawa H
        • Yasue H
        • Oshima S
        • Okumura K
        • Matsuyama K
        • Obata K
        Circadian variation of plasma fibrinopeptide A level in patients with variant angina.
        Circulation. 1989; 80: 1617-1626
        • Masuda T
        • Yasue H
        • Ogawa H
        • Misumi I
        • Sakamoto T
        • Okubo H
        • Miyao Y
        • Kato H
        Plasma plasminogen activator inhibitor activity and tissue plasminogen activator levels in patients with unstable angina and those with coronary spastic angina.
        Am Heart J. 1992; 124: 314-319
        • Masuda T
        • Ogawa H
        • Miyao Y
        • Yu Q
        • Misumi I
        • Sakamoto T
        • Okubo H
        • Okumura K
        • Yasue H
        Circadian variation in fibrinolytic activity in patients with variant angina.
        Br Heart J. 1994; 71: 156-161
        • Loskutoff D.J
        • Sawdey M
        • Mimuro J
        Type 1 plasminogen activator inhibitor.
        Prog Hemost Thromb. 1989; 9: 87-115
        • Yasue H
        • Takizawa A
        • Nagao M
        • Nishida S
        • Horie M
        • Kubota J
        • Omote S
        • Takaoka K
        • Okumura K
        Long-term prognosis for patients with variant angina and influential factors.
        Circulation. 1988; 78: 1-9
        • Dunn R.F
        • Kelly D.T
        • Sadick N
        • Uren R
        Multivessel coronary artery spasm.
        Circulation. 1979; 60: 451-455
        • Onaka H
        • Hirota Y
        • Shimada S
        • Kita Y
        • Sakai Y
        • Kawakami Y
        • Suzuki S
        • Kawamura K
        Clinical observation of spontaneous anginal attacks and multivessel spasm in variant angina pectoris with normal coronary arteries.
        J Am Coll Cardiol. 1996; 27: 38-44
        • Yasue H
        • Horio Y
        • Nakamura N
        • Fujii H
        • Imoto N
        • Sonoda R
        • Kugiyama K
        • Obata K
        • Morikami Y
        • Kimura T
        Induction of coronary artery spasm by acetylcholine in patients with variant angina.
        Circulation. 1986; 74: 955-963
        • Okumura K
        • Yasue H
        • Matsuyama K
        • Goto K
        • Miyagi H
        • Ogawa H
        • Matsuyama K
        Sensitivity and specificity of intracoronary injection of acetylcholine for the induction of coronary artery spasm.
        J Am Coll Cardiol. 1988; 12: 883-888
        • Eriksson E
        • Rånby M
        • Gyzander E
        • Risberg B
        Determination of plasminogen activator inhibitor in plasma using t-PA and a chromogenic single-point poly- D-lysine stimulated assay.
        Thromb Res. 1988; 50: 91-101
        • Amiral J
        • Plassart V
        • Grosley M
        • Mimilla F
        • Contant G
        • Guyader A.M
        Measurement of t-PA and t-PA–PAI-I complexes by ELISA, using monoclonal antibodies.
        Thromb Res. 1988; : 99-113
        • Hamsten A
        • De Faire U
        • Walldius G
        • Dahlen G
        • Szamosi A
        • Landou C
        • Blomback M
        • Wiman B
        Plasminogen activator inhibitor in plasma.
        Lancet. 1987; 2: 3-9
        • Juhan-Vague I
        • Pyke S.D.M
        • Alessi M.C
        • Jespersen J
        • Haverkate F
        • Thompson S.G
        • ECAT Study Group
        Fibrinolytic factors and the risk of myocardial infarction or sudden death in patients with angina pectoris.
        Circulation. 1996; 94: 2057-2063
        • Thögersen A.M
        • Jansson J.-H
        • Boman K
        • Nilsson T.K
        • Weinehall L
        • Huhtasaari F
        • Hallmans G
        High plasminogen activator inhibitor and tissue plasminogen activator levels in plasma precede a first myocardial infarction in both men and women. Evidence for the fibrinolytic system as an independent primary risk factor.
        Circulation. 1998; 98: 2241-2247