[Fibrinolytic system in patients with myocardial infarction and other coronary disease risk factors].
OBJECTIVE
To evaluate the fibrinolytic system function in survivors of acute myocardial infarction (AMI) and to appreciate the differences between patients with history of diabetes and/or dyslipaemia and those without such history.


METHODS
A series comprised of 101 patients (83 men and 18 women) surviving six months after AMI and with mean age of 61.7 +/- 8.5 years was studied. Previous history of type II diabetes mellitus was present in 22 cases, while 42 others had some type of dyslipaemia (16, hypertriglyceridaemia; 15, hypercholesterolaemia; 11 both). Of the patients with diabetes mellitus, 14 had also dyslipaemia (5, hypertriglyceridaemia; 6, hypercholesterolaemia; 3, both conditions). The rates of plasminogen-activator inhibitor (PAI-1), fibrinogen, plasminogen, and alpha-2-antiplasmin, along with the venous occlusion test to determine tissular plasminogen activator (t-PA), both functional and antigenic, before and after venous occlusion, were tested in all cases. The studies were performed at the moment of AMI and 6 months later.


RESULTS
PAI-1 concentration during AMI in the patients with some concurrent lipid anomaly showed significant differences with respect to the patients without any such associated disease (p < 0.001). The patients with history of dyslipaemia had significant increase of PAI-1 (p < 0.001) with respect to those without such history. Those patients with associated diabetes showed significantly increased PAI-1 concentration with regard to those without it, both in the acute phase and 6 months later (p < 0.05); significant increase was also found when comparing the patients with diabetes and dyslipaemia with those ones with only diabetes or dyslipaemia (p < 0.05). A significant increase of PAI-1 level (p < 0.001) was found in the 6-month study in the dyslipaemia patients with respect to non-dyslipaemic, and similar findings appeared with respect to diabetics and non-diabetics (p < 0.05). The 14 patients with both disorders showed increased values when compared with those having only one associated impairment (p < 0.05). When comparing the PAI-1 rates at AMI and 6 months later in the patients with dyslipaemia or diabetes, statistically significant decrease could be noted (p < 0.05 and p < 0.01, respectively). Before venous occlusion, t-PA was significantly increased in diabetic or dyslipaemic patients (p < 0.05) and in the patients with both conditions (p < 0.01).


CONCLUSIONS
Patients with AMI and abnormalities of the lipidic or glycaemic metabolism have fibrinolytic dysfunction on the basis of an increase of the main inhibitor of the fibrinolytic system and a decreased release of tissular plasminogen activator. Those patients with both metabolic abnormalities have a deeper fibrinolytic hypofunction, with higher PAI-1 concentration.
Moreno
J A
JA
Servicio de Hematología y Hemoterapia del Hospital Clínico Universitario de Zaragoza.
Gálvez
M M
MM
Cornudella
R
R
Angós
J A
JA
Romero
M S
MS
Gutiérrez
M
M
D000368:Aged; D003327:Coronary Disease / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D005342:Fibrinolysis; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000401:mortality; D010958:Plasminogen / Q000032:analysis; D017395:Plasminogen Activator Inhibitor 1 / Q000032:analysis; D010960:Plasminogen Activators / Q000032:analysis; D012307:Risk Factors; D017741:Survivors; D000979:alpha-2-Antiplasmin / Q000032:analysis
D017395:Plasminogen Activator Inhibitor 1; D000979:alpha-2-Antiplasmin; D005340:Fibrinogen; D010958:Plasminogen; D010960:Plasminogen Activators
Estudio del sistema fibrinolítico en pacientes con infarto de miocardio y otros factores de riesgo de enfermedad coronaria.