Effect Of Rosiglitazone On Fibrinolytic System And In-stent Restenosis In Patients With ACS Combined With IGT

Object: To investigate the effect of rosiglitazone on fibrinolytic system and in-stent restenosis in patients with acute coronary syndrome(ACS) combined with impaired glucose tolerance(IGT), by observing the variation of plasma levels of tissue-type plasminogen activator(t-PA), plasminogen activator inhibitor–1(PAI-1) and serum levels of high-sensitivity C-reactive protein(hs-CRP) of the patients who were treated with conventional therapy or conventional therapy with the addition of rosiglitazone before and 1 month after percutaneous coronary intervention(PCI) and the occurrence of in-stent restenosis.Method: 76 patients with ACS combined with IGT were randomly divided into Conventional group and Rosiglitazone group who treated with conventional therapy or conventional therapy with the addition of rosiglitazone for 1 month after PCI. 20 patients with IGT who were normality in coronary arteriography(CAG) were enrolled in IGT group, and 20 who were normality in oral glucose tolerance test(OGTT) and CAG were assigned in Control group. Plasma levels of t-PA, PAI-1 and serum levels of hs-CRP were determined before and 1 month after PCI. Restenosis related symptoms were observed in 6-month follow-up. CAGs were reexamined when the follow-up was over or symptoms appeared.Result:1. Compared with IGT group, plasma levels of PAI-1 and serum levels of hs-CRP in Conventional group and Rosiglitazone group were higher while plasma levels of t-PA were lower with statistically significant(P<0.05); Compared with Control group, plasma levels of PAI-1, and serum leves of hs-CRP in IGT group,Conventional group and Rosiglitazone group were higher while plasma levels of t-PA were lower significantly(P<0.05 and P<0.05,respectively); No significant difference was found between Conventional group and Rosiglitazone group(P>0.05).2. Plasma levels of t-PA were much higher 1 months later than before PCI in Conventional group and Rosiglitazone group while plasma levels of PAI-1 and serum levels of hs-CRP were much lower significantly(P<0.05); The increasing of t-PA levels and the decreasing of PAI-1 and hs-CRP levels were significantly higher in Rosiglitazone group than Conventional control group (P<0.05).3. The occurrence of restenosis was lower in Rosiglitazone group than Conventional group significantly(P<0.05); Plasma levels of t-PA were lower while plasma levels of PAI-1 and serum levels of hs-CRP were higher significantly in those who with restenosis than those without (P<0.05).4. Plasma levels of PAI-1were positively correlated with serum levels of hs-CRP (r=0.727,P<0.001)while plasma levels of t-PA were negatively correlated with it(r=0.693,P<0.001).Conclusion:1. Plasma levels of PAI-1 and t-PA may be valuable predictors of ACS in IGT patients.2. Plasma levels of PAI-1 and t-PA like to be predictors of restenosis after PCI probably.3. Rosiglitazone may reduce the occurrence of restenosis after PCI by raising the plasma level of t- PA and reducing the plasma level of PAI-1, indicating fibrinolytic system was activated.