Correlation of cross-linked fibrin degradation products (D-dimer) with coronary angiographic lesion morphology.

We tested the hypothesis that complex irregular coronary lesions are "active" lesions and thus associated with ongoing fibrinolysis by measuring the degradation products of cross-linked fibrin (D-dimer) in 136 patients undergoing coronary arteriography. Blood samples obtained before catheterization were assayed by an enzyme linked immunosorbent assay (ELISA) using specific monoclonal antibodies for D-dimer particles. In the four groups with complex coronary morphologies (filling defects, extrinsic lesions with irregular borders and total occlusions with or without staining) the majority of patients (64%) had normal D-dimer levels. The incidence of abnormal D-dimer levels was not significantly higher in any of these four groups than in the two groups with normal coronaries or with smooth lesions. In the same patients, however, the clinical diagnosis was predictive of the presence of elevated D-dimer levels. These findings suggest that complex coronary lesions are often not associated with ongoing fibrinolysis and that endogenous fibrinolysis frequently ceases in the presence of persistent clot.

Use of tissue plasminogen activator in the coronary care unit for acute closure after coronary angioplasty.

Coronary angioplasty in a patient ten days following myocardial infarction was complicated by repeated thrombotic occlusion requiring intracoronary streptokinase. Recurrence of chest pain and ST elevations after transfer to the coronary care unit was successfully managed with intravenous tissue plasminogen activator without returning the patient to the catheterization laboratory.