Circulation, Vol 88, 2030-2034, Copyright © 1993 by American Heart Association
JH Jansson, BO Olofsson and TK Nilsson
BACKGROUND. The fibrinolytic system is part of the defense against
thrombotic and cardiovascular events, but so far no study has shown that
clinical measurements of fibrinolytic key components such as tissue
plasminogen activator (t-PA) or plasminogen activator inhibitor type 1
(PAI-1) have any predictive value beyond 3 years. METHODS AND RESULTS. In
1983 through 1985, 213 consecutive patients with angina pectoris and
angiographically verified coronary artery disease were sampled, and the
mass concentration of t-PA and the activity of PAI-1 were measured in
citrated plasma samples. At a mean follow-up time of 7 years, the all-cause
mortality was checked. No patient was lost to follow-up. The data were
analyzed by Cox regression, and t-PA mass concentration was found to be the
only laboratory risk factor significantly related to mortality in all
patients (P < .022) and also in the major subgroup (78% of all patients)
subjected to coronary bypass surgery (P < .027). In the latter subgroup,
body mass index was also related to mortality. CONCLUSIONS. An increased
mass concentration of t-PA is a new risk factor of long-term mortality in
patients with angina pectoris and coronary artery stenosis. This
paradoxical effect probably reflects increased t-PA levels attributable to
enzyme inhibitor complex formation in subjects with increased plasma levels
of t-PA inhibitors.
ARTICLES
Predictive value of tissue plasminogen activator mass concentration on long-term mortality in patients with coronary artery disease. A 7-year follow-up
Department of Medicine, Skelleftea Hospital, Umea, Sweden.
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