Angiotensin-converting enzyme inhibition alters the fibrinolytic response to cardiopulmonary bypass

Increased plasminogen activator inhibitor-1 (PAI-1) concentrations after coronary artery bypass grafting (CABG) are associated with increased risk of vein graft occlusion. Because angiotensin II stimulates PAI-1 expression, we tested the hypothesis that preoperative angiotensin-converting enzyme (AC...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 2003-12, Vol.108 (25), p.3079-3083
Main Authors: PRETORIUS, Mias, MURPHEY, Laine J, MCFARLANE, Julie A, VAUGHAN, Douglas E, BROWN, Nancy J
Format: Article
Language:English
Subjects:
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Biological and medical sciences
Cardiopulmonary Bypass
Combined Modality Therapy
Coronary Artery Bypass
Female
Fibrinolysis
Graft Occlusion, Vascular - prevention & control
Hemodynamics
Humans
Male
Medical sciences
Middle Aged
Plasminogen Activator Inhibitor 1 - metabolism
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the heart
Tissue Plasminogen Activator - metabolism
Treatment Outcome
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Summary:Increased plasminogen activator inhibitor-1 (PAI-1) concentrations after coronary artery bypass grafting (CABG) are associated with increased risk of vein graft occlusion. Because angiotensin II stimulates PAI-1 expression, we tested the hypothesis that preoperative angiotensin-converting enzyme (ACE) inhibition decreases PAI-1 expression after CABG. We measured the effects of cardiopulmonary bypass (CPB) on PAI-1 antigen and tissue-type plasminogen activator (tPA) antigen and activity in 31 patients taking an ACE inhibitor (ACEI) who were randomized to continue ACEI until the morning of surgery (ACEI group, n=19) or to discontinue it 48 hours before surgery (No-ACEI group, n=12). Arterial blood samples were taken at baseline before CPB, twice during CPB, after separation from CPB, and on postoperative day 1 (POD1). CPB caused an early decrease in PAI-1 antigen, followed by an increase in PAI-1 antigen on POD1 (P
ISSN:0009-7322
1524-4539
DOI:10.1161/01.CIR.0000105765.54573.60