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DOI: 10.1055/s-0038-1648134
Correlation between Baseline Plasminogen Activator Inhibitor Levels and Clinical Outcome during Therapy with Tissue Plasminogen Activator for Acute Myocardial Infarction
Publikationsverlauf
Received: 07. Juni 1990
Accepted after revision 06. Oktober 1990
Publikationsdatum:
02. Juli 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035024/199103/lookinside/thumbnails/10-1055-s-0038-1648134-1.jpg)
Summary
Baseline plasminogen activator inhibitor (PAI) levels were examined for their influence on the responses to thrombolysis with recombinant tissue plasminogen activator (rt-PA) administered for acute myocardial infarction during the Thrombolysis and Myocardial Infarction (TAMI)-I study. Baseline PAI activity was 19 ± 21 IU/ml (normal <5 IU/ml) and baseline PAI-1 antigen 54 ± 53 ng/ml (normal 27 ± 16 ng/ml), confirming previous findings of elevated PAI levels during acute myocardial infarction. Among clinical outcomes, lower PAI-1 antigen levels correlated weakly with greater patency at the 90 min angiogram. Thus, high baseline plasma PAI-1 levels may be detrimental to reperfusion with t-PA. There was no correlation with other major in-hospital clinical outcomes including reocclusion at the 7-10 day angiogram, survival to discharge, or bleeding. During the follow up period of 2.0 ± 0.4 years, no relationship between baseline PAI levels and post-discharge reinfarction was observed.
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REFERENCES
- 1 Wilcox RG, Olsson CG, Skene AM, von der Lippe G, Jensen G, Hampton JR. ASSET Study Group. Trial of tissue plasminogen activator for mortality reduction in acute myocardial infarction: Anglo-Scandinavian Study of Early Thrombolysis (ASSET). Lancet 1988 2. 525-530
- 2 TIMI Study Group. The Thrombolysis in Myocardial Infarction trial: phase I findings. N Engl J Med 1985 312. 932-936
- 3 Topol EJ, Califf RM, George BS, Kereiakes DJ, Abbottsmith CW, Candela RJ, Lee KL, Pitt B, Stack RS, O’Neill WW. the TAMI Study Group A multicenter randomized trial of intravenous recombinant tissue plasminogen activator and immediate versus deferred angioplasty in acute myocardial infarction. N Engl J Med 1987 317. 581-588
- 4 Verstraete M, Bernard R, Bory M, Brower RW, Collen D, de Bono DP, Erbel R, Huhmann W, Lennane RJ, Lubsen J, Mathey D, Meyer J, Michels HR, Rutsch W, Schartl M, Schmidt W, Uebis R, von Essen R. Randomised trial of intravenous recombinant tissue-type plasminogen activator versus intravenous streptokinase in acute myocardial infarction. Lancet 1985; 1: 842-847
- 5 Ellis SG, Topol EJ, George BS, Kereiakes DJ, Debowey D, Sigmon KN, Pickel A, Lee KL, Califf RM. Recurrent ischemia without warning. Analysis of risk factors for in-hospital ischemic events following successful thrombolysis with intravenous tissue plasminogen activator. Circulation 1989; 80: 1159-1165
- 6 Kerins DM, Roy L, Fitzgerald GA, Fitzgerald DJ. Platelet and vascular function during coronary thrombolysis with tissue-type plasminogen activator. Circulation 1989; 80: 1718-1725
- 7 Eisenberg PR, Sherman LA, Jaffe AS. Paradoxic elevation of fibrinopeptide A after streptokinase: Evidence for continued thrombosis despite intense fibrinolysis. J Am Coll Cardiol 1987; 10: 527-529
- 8 Lee CD, Mann KG. Activation/inactivation of human factor V by plasmin. Blood 1989; 73: 185-190
- 9 Loskutoff DJ, Sawdey M, Mimuro J. Type 1 plasminogen activator inhibitor. In: Progress in Hemostasis and Thrombosis. Vol 9 Coller BS. (ed): W. B. Saunders Co; Philadelphia, PA: 1989: 87-115
- 10 Hamsten A, Wiman B, De Faire U, Blomback M. Increased levels of a rapid inhibitor of tissue plasminogen activator in young survivors of myocardial infarction. N Engl J Med 1985; 313: 1557-1563
- 11 Nilsson I, Lungher H, Tengborn L. Two different mechanisms in patients with venous thrombosis and defective fibrinolysis: low concentration of plasminogen activator or increased concentration of plasminogen activator inhibitor. Br Med J 1985; 290: 1453-1456
- 12 Landefeld CS, Cook EF, Hatley M, Weisberg M, Goldman L. Identification and preliminary validation of predictors of major bleeding in hospitalized patients starting anticoagulant therapy. Am J Med 1987; 82: 703-713
- 13 Califf RM, Topol EJ, George BS, Boswick JM, Abbottsmith C, Sigmon KN, Candela R, Masek R, Kereiakes D, O’Neill WW, Stack RS, Stump D. Hemorrhagic complications associated with the use of intravenous tissue plasminogen activator in the treatment of acute myocardial infarction. Am J Med 1988; 85: 353-359
- 14 Verheijen JH, Chang GTG, Kluft C. Evidence for the occurrence of a fast-acting inhibitor for tissue-type plasminogen activator in human plasma. Thromb Haemostas 1984; 51: 392-395
- 15 Declerck PJ, Alessi M-C, Verstreken M, Kruithof EKO, Juhan-Vague I, Collen D. Measurement of plasminogen activator inhibitor 1 in biologic fluids with a murine monoclonal antibody-based enzyme-linked immunosorbent assay. Blood 1988; 71: 220-225
- 16 Stump DC, Topol EJ, Chen AB, Hopkins A, Collen D. Monitoring of hemostasis parameters during coronary thrombolysis with recombinant tissue-type plasminogen activator. Thromb Haemostas 1988; 59: 133-137
- 17 Clauss A. Gerinnungsphysiologische Schnellmethode zur Bestim-mung des Fibrinogens. Acta Haematol 1957; 37: 237-246
- 18 Vermylen C, DeVreker RA, Verstraete M. A rapid enzymatic method for assay of fibrinogen fibrin polymerization time (FPT-test). Clin Chem Acta 1963; 8: 418-424
- 19 Rampling MW, Gaffney PJ. The sulphite precipitation method for fibrinogen measurement: its use on small sample in the presence of fibrinogen degradation products. Clin Chim Acta 1976; 67: 43-52
- 20 Holvoet P, Cleemput H, Collen D. Assay of human tissue-type plasminogen activator (t-PA) with an enzyme-linked immunosorbent assay (ELISA) based on three murine monoclonal antibodies to t-PA. Thromb Haemostas 1985; 54: 684-687
- 21 Merskey C, Lalezari P, Johnson AJ. A rapid, simple, sensitive method for measuring fibrinolytic split products in human serum. Proc Soc Exp Biol Med 1969; 131: 871-875
- 22 Stump DC, Califf RM, Topol EJ, Sigmon K, Thornton D, Masek R, Anderson L, Collen D. Pharmacodynamics of thrombolysis with recombinant tissue-type plasminogen activator: Correlation with characteristics of and clinical outcomes in patients with acute myocardial infarction. Circulation 1989; 80: 1222-1230
- 23 Almer L-O, Ohlin H. Elevated levels of the rapid inhibitor of plasminogen activator (t-PAI) in acute myocardial infarction. Thromb Res 1987; 47: 335-339
- 24 Juhan-Vague I, Moerman B, DeCock F, Aillaud MF, Collen D. Plasma levels of a specific inhibitor of tissue-type plasminogen activator (and urokinase) in normal and pathologic conditions. Thromb Res 1984; 33: 523-530
- 25 Kluft C, Verheijen JH, Jie AFH, Rijken DC, Preston FE, Sue-Ling HM, Jespersen J, Aasen AD. The postoperative fibrinolytic shutdown: A rapidly reverting acute phase pattern for the fast-acting inhibitor of tissue-type plasminogen activator after trauma. Scand J Clin Lab Invest 1985; 45: 605-610
- 26 Kruithof EKO, Nicolosa G, Bachmann F. Plasminogen activator inhibitor 1: Development of a radioimmunoassay and observations on its plasma concentration during venous occlusion and after platelet aggregation. Blood 1987; 70: 1645-1653
- 27 Aillaud MF, Pignol F, Alessi MC, Harle JR, Escande M, Mongin M, Juhan-Vague I. Increase in plasma concentration of plasminogen activator inhibitor, fibrinogen, von Willebrand factor, factor VIII:C, and in erythrocyte sedimentation rate with age. Thromb Haemostas 1986; 55: 330-332
- 28 Kruithof EKO, Tran-Thang C, Ransijn A, Bachmann F. Demonstration of a fast-acting inhibitor of plasminogen activators in human plasma. Blood 1984; 64: 907-913
- 29 Lucore CL, Sobel BE. Interactions of tissue-type plasminogen activator with plasma inhibitors and their pharmacologic implications. Circulation 1988; 77: 660-669
- 30 Sprengers ED, Kluft C. Plasminogen activator inhibitors. Blood 1987; 69: 381-387
- 31 Stump D, Topol E, Sigmon K, Stoddard M, Califf R. Pronounced sensitivity of blacks to tissue-type plasminogen activator (rt-PA) for acute myocardial infarction (abstract). Circulation 1988; 78: 275
- 32 Barbash GI, Hod H, Roth A, Miller HI, Rath S, Zahav YH, Modan M, Zivelin A, Laniado S, Seligsohn U. Correlation of baseline plasminogen activator inhibitor activity with patency of the infarct artery after thrombolytic therapy in acute myocardial infarction. Am J Cardiol 1989; 64: 1231-1235
- 33 Lucore CL, Fujii S, Sobel BE. Dependence of fibrinolytic activity on the concentration of free rather than total tissue-type plasminogen activator in plasma after pharmacologic administration. Circulation 1989; 79: 1204-1213
- 34 Hamsten A, Walldius G, Szamosi A, Blomback M, de Faire U, Dahlen G, Landou C, Wiman B. Plasminogen activator inhibitor in plasma: Risk factor for recurrent myocardial infarction. Lancet 1987; 2: 3-8
- 35 Jang I-K, Gold HK, Ziskind AA, Fallon JT, Holt RE, Leinbach RC, May JW, Collen D. Differential sensitivity of erythrocyte-rich and platelet-rich arterial thrombi to lysis with recombinant tissue-type plasminogen activator. A possible explanation for resistance to coronary thrombolysis. Circulation 1989 79. 920-928