Tissue-type plasminogen activator and plasminogen activator inhibitor activities as predictors of adverse events in unstable angina.
Among patients with recent-onset unstable angina and evidence of ischemia or coronary artery disease, the incidence of subsequent cardiovascular events is high. The aim of this study was to investigate, in this high-risk population, whether unstable angina was associated with abnormalities of tissue-type plasminogen activator (t-PA) or plasminogen activator inhibitor (PAI) activities and whether, in a prospective study, any of these parameters would identify patients with an adverse cardiovascular prognosis. A group of 22 high-risk patients with unstable angina (64% event rate at 3 months) was studied prospectively for 12 weeks, and the fibrinolytic parameters measured at presentation were related to subsequent cardiovascular progress. A group of 20 age- and sex-matched healthy subjects acted as control subjects. Patients who had subsequent cardiovascular events (acute myocardial infarction or severe recurrent angina +/- intervention) had significantly elevated PAI activity at presentation compared with both those who remained event-free (p < 0.05) or with control subjects (p < 0.02). In addition, basal activation of fibrinolysis was demonstrated in unstable angina at presentation; this persisted at 9 weeks in patients with a favorable outcome (p < 0.02 vs control subjects), whereas it was no longer evident in those who developed cardiac events. These findings suggest that measurements of t-PA/PAI activity may reflect the underlying pathophysiologic state and relate to subsequent cardiovascular events in unstable angina.
Wieczorek
I
I
Cardiovascular Research Unit, University of Edinburgh, Scotland.
Ludlam
C A
CA
Fox
K A
KA
D000368:Aged; D000789:Angina, Unstable / Q000188:drug therapy / Q000503:physiopathology*; D001779:Blood Coagulation Factors / Q000187:drug effects; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015849:Plasminogen Inactivators / Q000494:pharmacology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D010959:Tissue Plasminogen Activator / Q000494:pharmacology*
D001779:Blood Coagulation Factors; D015849:Plasminogen Inactivators; D010959:Tissue Plasminogen Activator