Tissue plasminogen activator on admission is an important predictor of 30-day mortality in patients with acute myocardial infarction undergoing primary angioplasty.
Tissue plasminogen activator (tPA) is emerging as an important risk factor for coronary heart disease, but the association between tPA concentration and mortality in acute myocardial infarction (AMI) remains uncertain. We studied the relationship between tPA antigen level on admission and 30-day mortality in 226 consecutive patients with AMI undergoing primary angioplasty. Death within 30 days occurred in 13 patients (5.7%). The concentration of tPA was significantly higher among the 13 patients who died than among the 213 who survived (26.5+/-16.3 versus 12.5+/-8.5 ng/mL, p<0.001). Compared with those in the lowest quartile (<9 ng/mL), patients in the highest quartile (>16 ng/mL) had a relative risk of subsequent death of 13.1 (p=0.014). In a Cox regression model, a tPA concentration >19 ng/mL was independently associated with mortality (HR 12.1, 95% CI, 1.9-76.7, p=0.001). This cutoff value had a 76.9% sensitivity and an 85.9% specificity for predicting 30-day mortality. tPA concentration was also higher in patients with severe heart failure (20.9+/-14.2 ng/mL versus 11.7+/-7.5 ng/mL, p=0.001) or ventricular tachyarrhythmia (24.3+/-13.9 ng/mL versus 12.2+/-8.4 ng/mL, p=0.001). In conclusions, elevated tPA antigen at initial presentation in patients with AMI was associated with higher short-term risk of death, suggesting that tPA may be a useful prognostic biomarker for the early risk stratification of these patients.
Lee
Cheol Whan
CW
Department of Medicine, Asan Medical Center, University of Ulsan, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
Ahn
Jung-Min
JM
Department of Medicine, Asan Medical Center, University of Ulsan, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
Park
Duk-Woo
DW
Department of Medicine, Asan Medical Center, University of Ulsan, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
Kim
Young-Hak
YH
Department of Medicine, Asan Medical Center, University of Ulsan, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
Hong
Myeong-Ki
MK
Department of Medicine, Asan Medical Center, University of Ulsan, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
Song
Jae-Kwan
JK
Department of Medicine, Asan Medical Center, University of Ulsan, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
Kim
Jae-Joong
JJ
Department of Medicine, Asan Medical Center, University of Ulsan, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
Park
Seong-Wook
SW
Department of Medicine, Asan Medical Center, University of Ulsan, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
Chi
Hyun-Sook
HS
Department of Clinical Pathology, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea.
Park
Seung-Jung
SJ
Department of Medicine, Asan Medical Center, University of Ulsan, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea. Electronic address: sjpark@amc.seoul.kr.
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007723:Korea / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality* / Q000628:therapy; D012372:ROC Curve; D012307:Risk Factors; D010959:Tissue Plasminogen Activator / Q000097:blood*
D015415:Biomarkers; D010959:Tissue Plasminogen Activator