Endothelial dysfunction and hemostasis system in patients with acute coronary syndrome with ST segment elevation after percutaneous coronary intervention with stenting

The aim of this study was to determine the features of endothelial dysfunction and hemostasis in patients with ST"segment elevation acute coronary syndrome (n=158) after percutaneous coronary intervention (PCI) with bare metal stents stenting of the infarct"related artery and to identify possible predictors of the complications such as thrombosis and stent restenosis. At baseline (5-7 days after stenting), all patients underwent the examination of the hemostasis system markers and the evaluation of the endothelial dysfunction via quantifying the levels of the intercellular adhesion molecules: sVCAM, sICAM, sP"selektine, and sE"selektine. The criterion for the assignment of patients into groups was the presence of repeated cases of acute coronary syndrome due to in"stent restenosis and stent thrombosis according to the results of coronary angiography within 12"month follow"up. The study demonstrated the potential predictive values of (i) endothelial dysfunction markers (sICAM"1, sVCAM"1, SP"selectine) for the prediction of the development of complications such as recurrent acute coronary syndrome after stenting and (ii) sP"selectinе for the prediction of stent thrombosis. The identified hemostatic disorders were characterized by an increased ADP"induced platelet response in the presence of dual antiplatelet therapy (2ATT) and were caused by resistance to clopidogrel; the presence of the identified hemostatic disorders predicted the development of the complications such as stent thrombosis in patients with ST"segment elevation acute coronary syndrome after PCI. The study showed direct correlation between sP"selectin and ADP"induced platelet aggregation suggesting the important role of inflammation in the development of resistance to antiplatelet drugs.