Lipoprotein(a) levels in patients with myocardial infarction treated with anistreplase: no prediction of efficacy but inverse correlation with plasminogen activation in non-patency.
The aim of this study was to investigate whether failure of thrombolytic treatment might be due to inhibition of fibrinolysis by high lipoprotein(a) levels. Fifty-eight patients with acute myocardial infarction were treated intravenously within 4 h after onset of symptoms with anistreplase (30 units) and heparin (30,000 IU/24 h). Blood samples for measurement of coagulation parameters were taken before and 1.5 h after treatment. Coronary angiography was performed after 48 h. Levels of lipoprotein(a) were measured 6 months after discharge from hospital. The patency rate was 74% (43/58). Median lipoprotein(a) levels were not different between the patients with a patent and those with a non-patent vessel (10 and 8 mg/dl, respectively), however, in patients with a non-patent infarct-related vessel, a significant inverse correlation was found between the lipoprotein(a) level and the decrease of plasminogen in the first 1.5 h after treatment. It is concluded that high lipoprotein(a) levels, although not directly associated with a poor outcome of anistreplase therapy, might contribute to insufficient fibrinolysis in patients with a non-patent infarct-related vessel.
Department of Cardiology, Thoraxcenter, University Hospital Groningen, Netherlands.
J
J
Brügemann
J
J
van der Meer
H L
HL
Hillege
A J
AJ
van Boven
J J
JJ
van Doormaal
P A
PA
de Graeff
K I
KI
Lie
D000328:Adult; D000368:Aged; D016255:Anistreplase / Q000008:administration & dosage*; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects*; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D005342:Fibrinolysis / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy*; D010958:Plasminogen / Q000378:metabolism*; D016896:Treatment Outcome; D000979:alpha-2-Antiplasmin / Q000378:metabolism
D017270:Lipoprotein(a); D000979:alpha-2-Antiplasmin; D016255:Anistreplase; D005340:Fibrinogen; D010958:Plasminogen