2014


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2014/№5

Vascular-platelet hemostasis and endothelial dysfunction in patients with ST segment elevation ACS after percutaneous intervention with stenting

Fadeeva E. A., Kotovshchikova E. F., Efremushkina A. A., Buevich E. I.

Keywords: hemostasis, dysfunction of endothelium, ACS, stenting, transcutaneous coronary intervention


DOI: 10.18087/rhj.2014.5.1978

Background. Post-stenting complications including restenosis (RS) and stent thrombosis (ST) are a challenge for current angiology. Aim. To determine peculiarities of disturbed vascular-platelet unit of hemostasis and endothelial dysfunction (ED) in patients with ST-segment elevation ACS after percutaneous coronary interventions (PCI) with stenting and to identify possible predictors of the RD and ST complications. Materials and methods. Parameters of the vascular-platelet unit of hemostasis and inflammation and ED markers (sP-selectin and sE-selectin) were measured at baseline (5–7 days of stenting) for all patients. Patients were divided into groups based on the presence of repeated ACS induced by RD and ST documented by coronary angiography (CAG) during the 12‑month follow-up. Results. The disorders of hemostasis system found in patients with ST-segment elevation ACS who have had PCI with stenting and received a double antiaggregation treatment were due to the resistance to antiaggregation drugs, including clopidogrel (19.62 % of patients) and aspirin (18.35 % of patients). These patients also had ED characterized by high levels of the inflammatory markers, P- and Е-selectins. Levels of sP-selectin directly correlated with platelet ADP-aggregation, which suggested an important role of inflammation in development of the resistance to antiaggregation drugs (r=0.72; р<0.05). Conclusion. The study demonstrated a predictive significance of the ED marker, sP-selectin, and the role of the aspirin and clopidogrel resistance in development of RD and ST complications in patients with ST-segment elevation ACS after PCI with stenting, during the 1‑year follow-up.
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Fadeeva E. A., Kotovshchikova E. F., Efremushkina A. A. et al. Vascular-platelet hemostasis and endothelial dysfunction in patients with ST segment elevation ACS after percutaneous intervention with stenting. Russian Heart Journal. 2014;79 (5):287–293

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