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on July 14, 2003

A more recent version of this article appeared on July 29, 2003

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Submitted on November 22, 2002
Revised on May 22, 2003
Accepted on June 6, 2003

Acute Release of Plasminogen Activator Inhibitor-1 in ST-Segment Elevation Myocardial Infarction Predicts Mortality

J. P. Collet MD, PhD, G. Montalescot MD, PhD^*, E. Vicaut MD, PhD, A. Ankri MD, F. Walylo MD, C. Lesty PhD, R. Choussat MD, F. Beygui MD, M. Borentain MD, N. Vignolles BSc, and D. Thomas MD

From the Institut de Cardiologie (J.P.C., G.M., F.W., R.C., F.B., M.B., N.V., D.T.) and Laboratory of Haemostasis (A.A., C.L.), Pitié-Salpêtrière Hospital, and the Department of Biostatistics (E.V.), Fernand Vidal Hospital, Paris, France.

^* To whom correspondence should be addressed. E-mail: gilles.montalescot{at}psl.ap-hop-paris.fr.

Background--A few studies have suggested that von Willebrand factor (vWF) or plasminogen activator inhibitor-1 (PAI-1) can be associated with outcomes of acute coronary syndromes. The present study was designed to assess the acute release of these markers in ST-segment elevation myocardial infarction (STEMI) and their relations to death.

Methods and Results--In 153 consecutive patients with STEMI, vWF and PAI-1 antigens were measured on admission (H0) and 24 hours later (H24). At 30 days, the death rate was 7.2%. Heart failure (Killip stage 3) on admission was present in 13.7% of patients. The acute release of PAI-1 (H24-H0, in ng/mL) and of vWF (H24-H0, in %) was dramatically higher in patients who died than in those who survived (46.9±26.3 versus -0.6±2.8 ng/mL, P=0.0001 and 65.8±20.0% versus 10.0±5.1%, P=0.004 for PAI-1 and vWF, respectively) and in patients developing heart failure compared with those without (24.8±10.1 versus -1.1±3.3 ng/mL, P=0.004 and 47.3±11.0% versus 8.1±5.6%, P=0.005 for PAI-1 and vWF, respectively). The release of PAI-1 correlated weakly with the left ventricular ejection fraction (R=-0.195, P=0.01) and the peak of troponin (R=0.149, P=0.045). Postangioplasty TIMI-3 flow and the acute release of PAI-1 were the only 2 independent predictors of death at 30 days.

Conclusions--The acute release of vWF and PAI-1 over the first 24 hours of STEMI is associated with death and heart failure. The acute rise of PAI-1 is also a strong independent predictor of death at 30 days.

Key words: myocardial infarction • platelets • inflammation

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