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European Heart Journal 1989 10(4):323-333;
Copyright © 1989 by the European Society of Cardiology.
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© 1989 The European Society of Cardiology

Fibrin formation and platelet activation in patients with myocardial infarction and normal coronary arteries

H. J. RAPOLD, A. HAEBERLI*, H. KUEMMERLI, M. WEISS, H. R. BAUR and W. P. STRAUB

Section of Cardiology and Thrombosis Research Laboratory Department of Medicine, University of Bern Medical School Bern Switzerland
*Section of Cardiology and Thrombosis Research Laboratory, University of Bern Medical School Bern Switzerland

Received 19 May 1988; revised 14 October 1988; .

Address for reprints: Hans J. Rapold MD, Section of Cardiology, Department of Medicine, University of Bern Medical School, Inselspital, CH-3010 Bern, Switzerland.

Abstract

Coronary spasm is the mechanism most often postulated to explain the rare combination of myocardial infarction and angiographically normal coronary arteries, although the reported evidence for its role is circumstantial rather than conclusive. Whereas the importance of thrombosis in myocardial infarction is uncontested in the presence of significant coronary artery disease, there is little in vivo evidence for thrombosis in angiographically normal coronary arteries.

Among 11 consecutive patients with acute myocardial infarction undergoing thrombolytic therapy with recombinant tissue plasminogen activator (rtPA) 3.2 ± 0.7h after onset of chest pain, and angiography 10.2 ± 4.5 days later, three young men had normal coronary arteries. Their cases are documented electrocadiographically, enzymatically and angiographically. Mean plasma levels of fibrinopeptide A (FPA) and beta-thromboglobulin (BTG) were clearly elevated before and during rtPA therapy: FPA 52 ± 41 ng ml-1, BTG 257 ± 46 ng ml-1. They did not differ significantly from corresponding mean plasma levels in the eight patients with severe coronary artery disease: FPA 67 ± 66 ng ml-1, BTG 181 ± 75 ng ml-1.

We conclude that fibrin formation and platelet activation are probably equally important in the early hours of myocardial infarction, whether or not significant coronary artery disease is present.

Key Words: Myocardial infarction with normal coronary arteries • Thrombosis • Spasm • fibrinopeptide A • beta-thromboglobulin


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