The Relationship Between Intimal Tears During Coronary Angioplasty and Fibrinopeptide A

Arterial injury during routine percutaneous trans‐luminal coronary angioplasty (PTCA) may stimulate clotting mechanisms. Excessive (i.e., angiographically visible) arterial trauma might accordingly predispose to a greater tendency for thrombosis. This study evaluates whether arterial trauma (i.e., angiographically visible intimal tears and arterial dissections) is related to evidence of active thrombosis. Fibrinopeptide A (FPA), a sensitive marker of thrombin activity, was measured in 79 patients undergoing elective PTCA immediately following angioplasty, as well as prior to hospital discharge (mean 2 days post‐PTCA). Levels > 2.0 ng/mL were considered elevated. Intimal tears were visualized in 41 patients. Of these 41, 31 had elevated FPA levels (sensitivity = 0.76). This association between FPA elevation and intimal tears was significant (P = 0.033). Of the remaining 38 patients without intimal tears, 20 had elevated FPA levels (specificity = 0.47). Concomitant arterial dissection, as well as an intimal tear, was found in four patients with elevated FPA and in one patient with normal FPA. Conclusion. Arterial trauma during PTCA is accompanied by a greater degree of ongoing thrombosis. Although FPA elevation was not specific for intimal tears, a highly significant association with intimal tears was observed. Further study may yield even more specific hematologic parameters on ongoing early thrombosis following PTCA, particularly in patients with intimal tears. (J Interven Cardiol 1989:2:3)