title: Evidence for reduced fibrinolytic activity in unstable angina at rest. Clinical, biochemical, and angiographic correlates.
abstract: BACKGROUND
  The goal of this study was to evaluate the role of the fibrinolytic system in patients with unstable angina at rest associated with transient electrocardiographic changes.
  
  
  RESULTS
  Tissue plasminogen activator activity in plasma was comparable among patients with unstable angina (n = 17), patients with stable exertional angina (n = 10), and control patients with normal coronary arteriograms (n = 8). In contrast, plasminogen activator inhibitor-1 (PAI-1) activity in plasma was elevated in the unstable angina group (21.67 +/- 9.52 AU/ml) as compared with either the stable angina group (12.01 +/- 7.06 AU/ml, p less than 0.02) or the controls (12.49 +/- 8.54 AU/ml, p less than 0.02). Coronary angiography performed within 24 hours after the last anginal episode showed a similar extent of coronary artery disease in the unstable and stable angina groups. However, intracoronary thrombi were observed in eight patients in the unstable angina group while no thrombus was noted in the stable angina group (chi 2 = 7.22, p less than 0.01).
  
  
  CONCLUSIONS
  We conclude that patients with unstable angina at rest have a reduced fibrinolytic activity and an increased incidence of intracoronary thrombi. It is postulated that elevated PAI-1 activity in the presence of coronary arterial wall injury may be an important factor leading to the development of acute coronary syndromes.
authors.affiliation: Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA 19107.
authors.forename: A
authors.initials: A
authors.lastname: Zalewski
authors.forename: Y
authors.initials: Y
authors.lastname: Shi
authors.forename: D
authors.initials: D
authors.lastname: Nardone
authors.forename: B
authors.initials: B
authors.lastname: Bravette
authors.forename: P
authors.initials: P
authors.lastname: Weinstock
authors.forename: D
authors.initials: D
authors.lastname: Fischman
authors.forename: P
authors.initials: P
authors.lastname: Wilson
authors.forename: S
authors.initials: S
authors.lastname: Goldberg
authors.forename: D C
authors.initials: DC
authors.lastname: Levin
authors.forename: T D
authors.initials: TD
authors.lastname: Bjornsson
mesh_terms: D000787:Angina Pectoris / Q000097:blood / Q000000981:diagnostic imaging; D000789:Angina, Unstable / Q000097:blood* / Q000000981:diagnostic imaging; D000792:Angiography; D017023:Coronary Angiography; D005342:Fibrinolysis; D006801:Humans; D015849:Plasminogen Inactivators / Q000032:analysis; D012146:Rest; D010959:Tissue Plasminogen Activator / Q000032:analysis
chemical_list: D015849:Plasminogen Inactivators; D010959:Tissue Plasminogen Activator