Risk stratification in patients with unstable angina and/or non-ST-elevation myocardial infarction by Troponin T and plasminogen-activator-inhibitor-1 (PAI-1).
BACKGROUND
Increased Troponin T (TnT) and PAI-1 levels are markers of poor outcome in acute coronary syndromes (ACS). In order to stratify the risk for 30-day combined endpoint of mortality and/or reinfarction in unstable angina and/or non-ST-elevation myocardial infarction (UA/NSTEMI), TnT and PAI-1 levels were simultaneously assessed.


METHODS
The TnT and PAI-1 levels of 113 patients with UA/NSTEM were estimated within the first 48 h. Initial therapy was medical. Percutaneous coronary interventions were performed in case of recurrent ischemia and/or hemodynamic and/or rhythmic instability.


RESULTS
Statistically significant differences in mean admission PAI-1 (4.2+/-3.4 vs. 2.8+/-2.4 U/ml, p<0.05), mean peak PAI-1 levels within the first 48 h (4.98 +/- 3.1 vs. 3.4 +/- 2.5 U/ml, p < 0.05), and no significant difference in any TnT level were observed between patients with and without 30-day mortality and/or reinfarction. The risk for 30-day mortality and/or reinfarction significantly increased in patients with admission PAI-1 levels > 4.0 U/ml (OR=4.44, 95%CI=1.47-13.4), peak PAI-1 levels > 4.0 U/ml (OR=5.78, 95%CI=1.838-18.20) and with simultaneously increased peak PAI-1 > 3.5 U/ml and TnT > 0.1 microg/l within the first 48 h (OR=4.9, 95%CI=1.569-15.385).


CONCLUSIONS
Simultaneous assessment of TnT and PAI-1 would provide complementary prognostic information and enable clinicians to stratify risk more effectively among patients with UA/NSTEMI.
Sinkovic
Andreja
A
Department for Medical Intensive Care, Teaching Hospital Maribor, Ljubljanska 5, 2000, Maribor, Slovenia. andreja.sinkovic@guest.arnes.si
Pogacar
Vojko
V
D000368:Aged; D000787:Angina Pectoris / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D012008:Recurrence; D018570:Risk Assessment; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D017395:Plasminogen Activator Inhibitor 1; D020107:Troponin T