[Evolution of fibrinolysis status with D-dimer level and the rate of plasminogen activator inhibitor type-1/D-dimer in acute coronary syndrome patients complicated with impaired glucose tolerance].
OBJECTIVE
To study the status of fibrinolytic inhibition in patients with acute coronary syndrome (ACS) complicated with impaired glucose tolerance (IGT) and to evaluate the effect of fibrinolytic inhibition on treatment and prognosis.


METHODS
The subjects were divided into three groups included 39 patients with ACS without diabetes mellitus, 37 patients with IGT+ACS and 36 patients with ACS+noninsulin-dependent diabetes mellitus (NIDDM). Twenty healthy people were randomized to be control group. The plasma levels of tissue type plasminogen activator (t-PA), plasminogen activator inhibitor type-1 (PAI-1) and plasma D-dimer were detected by enzyme linked immunoadsorbent assay (ELISA) technique. The index of status of fibrinolysis was detected with the plasma levels of PAI-1, D-dimer and the ratio of PAI-1/D-dimer. This index was used to evaluate the status of fibrinolytic inhibition and the clinical out come in patients with AMI.


RESULTS
Plasma level of PAI-1 was significantly higher in IGT+ACS patients and NIDDM +ACS patients than that in ACS(P<0.05), but the plasma level of D-dimer raised from basic level was significantly lower in IGT+ ACS patients and NIDDM+ACS patients than that in ACS (P<0.05). The ratio of PAI-1/D-dimer was significantly higher in IGT+ACS patients and NIDDM +ACS patients than that in ACS or in control group (P<0.01). For AMI patients in treatment groups, the rate of reperfusion after the thrombolytic was significantly lower and the rate of incidences in pump failure was significantly higher in IGT+ACS patients and NIDDM+ACS patients than that in ACS, too (P<0.01 and P<0.05). The incidences of serious arrhythmia, re-infarction and death were also higher in IGT+ACS patients and NIDDM +ACS patients.


CONCLUSIONS
The fibrinolytic inhibition is existed in IGT+ACS group patients. The plasma level of D-dimer combined with the ratio of PAI-1/D-dimer could be used to be the evidence and to be the index to evaluate the status of fibrinolytic inhibition and prognosis.
Wu
Wo-dong
WD
Department of Cardiology, Guangzhou Second Municipal People's Hospital, Guangzhou 510150, Guangdong, China.
Xu
Yun-hong
YH
Tan
Pei-yi
PY
D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000503:physiopathology*; D001786:Blood Glucose / Q000378:metabolism*; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D005342:Fibrinolysis; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D017395:Plasminogen Activator Inhibitor 1; D011379:Prognosis; D010959:Tissue Plasminogen Activator / Q000378:metabolism
D001786:Blood Glucose; D005338:Fibrin Fibrinogen Degradation Products; D005343:Fibrinolytic Agents; D017395:Plasminogen Activator Inhibitor 1; C051321:SERPINE1 protein, human; C036309:fibrin fragment D; C067262:PLAT protein, human; D010959:Tissue Plasminogen Activator