Increased plasminogen activator inhibitor activity and diabetes predict subsequent coronary events in patients with angina pectoris.
BACKGROUND
Plasminogen activator inhibitor (PAI) is a marker of recurrence of myocardial infarction. Diabetes mellitus is also an important risk factor of coronary artery disease, including myocardial infarction and angina pectoris.


OBJECTIVE
We examined baseline plasma PAI activity levels, clinical variables, and angiographic findings and assessed them as prospective values for subsequent coronary events, such as sudden death, nonfatal myocardial infarction and coronary revascularization by percutaneous transluminal coronary angioplasty or coronary artery bypass surgery during the follow-up period.


METHODS
We conducted a prospective study for 4 years of 249 consecutive patients admitted with angina pectoris. Blood samples for PAI were drawn at discharge.


RESULTS
In the multivariate Cox proportional hazard model, PAI activity and diabetes mellitus were significant and independent risk factors (the risk increased by 10% in those with a higher PAI concentration and by 70% in diabetic patients). Event-free survival was reduced by higher PAI activity (> or = 8.4 IU/mL) and the presence of diabetes. The patients with higher PAI activity and diabetes had a 4.2-fold risk in comparison with the patients with lower PAI activity and no diabetes. However, patients with lower PAI activity were less likely to have coronary events even when they had diabetes.


CONCLUSIONS
Higher PAI activity and diabetes predict subsequent coronary events in patients with angina pectoris. Diabetes has less prognostic value for subsequent coronary events in patients with lower PAI activity.
Takazoe
K
K
Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Japan.
Ogawa
H
H
Yasue
H
H
Sakamoto
T
T
Soejima
H
H
Miyao
Y
Y
Kawano
H
H
Moriyama
Y
Y
Misumi
K
K
Suefuji
H
H
Kugiyama
K
K
Yoshimura
M
M
D000787:Angina Pectoris / Q000097:blood* / Q000503:physiopathology; D003327:Coronary Disease / Q000401:mortality / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D015849:Plasminogen Inactivators / Q000097:blood; D011237:Predictive Value of Tests; D013997:Time Factors
D015849:Plasminogen Inactivators