Title
Fibrinolytic factors and the risk of myocardial infarction or sudden death in patients with angina pectoris
Author
Juhan-Vague, I.
Pyke, S.D.M.
Alessi, M.C.
Jespersen, J.
Haverkate, F.
Thompson, S.G.
Hematology Laboratory, CHU Timone, Marseille, France Medical Statistics Unit, London (UK) Sch. of Hyg./Trop. Med. Centralsygehuset, Esbjerg, Denmark Gaubius Laboratory Hematology Laboratory, CHU Timone, 13385 Marseille Cedex 5, France TNO Preventie en Gezondheid
Publication year
1996
Abstract
Background: Disturbances of the fibrinolytic system that lead to decreased removal of fibrin deposits may be important risk factors for coronary thrombosis. There is as yet no consensus on the prognostic value of fibrinolytic parameters, which may be attributed in part to the choice of confounding variables controlled for. Methods and Results: The ECAT study is a prospective multicenter study of 3043 patients with angina pectoris followed for 2 years. Baseline measurements included 10 fibrinolytic variables. The results were analyzed in relation to the subsequent incidence of myocardial infarction or sudden coronary death. They are presented before and after adjustment for clusters of confounding variables that are markers of different mechanisms: insulin resistance (body mass index, triglyceride, and HDL cholesterol), inflammation (fibrinogen and C-reactive protein), and endothelial cell damage (von Willebrand factor). An increased incidence of events was associated with higher baseline concentrations of tissue plasminogen activator (TPA) antigen (P=.0002), plasminogen activator inhibitor-1 (PAI-1) activity (P=.02), and PAI-1 antigen (P=.001). The associations of PAI-1 activity and PAI-1 antigen with risk of events disappeared after adjustment for parameters reflecting insulin resistance but were not affected by other adjustments. TPA antigen was affected to a similar extent by adjustment for parameters reflecting insulin resistance, inflammation, or endothelial cell damage, but the risk association disappeared only after combined adjustments. Conclusions: The prognostic role of PAI-1 in predicting coronary events is related principally to insulin resistance, whereas that of TPA antigen could be explained only by its relationship with different mechanisms, including insulin resistance, inflammation, and endothelial cell damage. Chemicals/CAS: Biological Markers; Fibrinogen, 9001-32-5; Plasminogen Activator Inhibitor 1; Tissue Polypeptide Antigen; von Willebrand Factor
Subject
Biology
angina
fibrinolysis
myocardial infarction
plasminogen activators
risk factors
angina pectoris
article
coronary artery thrombosis
coronary risk
female
fibrinolysis
heart infarction
human
major clinical study
male
priority journal
risk assessment
risk factor
sudden death
Adult
Angina Pectoris
Biological Markers
Death, Sudden
Female
Fibrinogen
Fibrinolysis
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Infarction
Plasminogen Activator Inhibitor 1
Predictive Value of Tests
Prognosis
Prospective Studies
Risk Factors
Tissue Polypeptide Antigen
von Willebrand Factor
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http://resolver.tudelft.nl/uuid:228484a2-2a70-42b0-81f3-01364316db32
TNO identifier
233549
ISSN
0009-7322
Source
Circulation, 94 (9), 2057-2063
Document type
article