ENZYMATIC EVIDENCE OF IMPAIRED REPERFUSION IN DIABETIC-PATIENTS AFTERTHROMBOLYTIC THERAPY FOR ACUTE MYOCARDIAL-INFARCTION - A ROLE FOR PLASMINOGEN-ACTIVATOR INHIBITOR
Rp. Gray et al., ENZYMATIC EVIDENCE OF IMPAIRED REPERFUSION IN DIABETIC-PATIENTS AFTERTHROMBOLYTIC THERAPY FOR ACUTE MYOCARDIAL-INFARCTION - A ROLE FOR PLASMINOGEN-ACTIVATOR INHIBITOR, British Heart Journal, 70(6), 1993, pp. 530-536
Objective-To compare the activity of plasminogen activator inhibitor (
PAI-1) in diabetic and non-diabetic patients admitted with acute myoca
rdial infarction and to determine whether PAI-I activity influences re
perfusion after thrombolytic therapy. Design-Prospective study of pati
ents admitted with acute myocardial infarction. Setting-District gener
al hospital. Main outcome measures-Reperfusion assessed by time to pea
k release of creatine kinase-MB isoenzyme. Results-Baseline PAI-1 acti
vity and antigen concentrations were significantly higher in diabetic
patients (n = 45) than in non-diabetic patients (n = 100) (24.6 (6.9)
nu 18.6 (7.9) AU/ml (AU = arbitrary units) (p = 0.0001) and 58.8 (13.1
-328 8) nu 41.0 (10.9-125.4) ng/ml (p = 0.004). Time to peak release o
f creatine kinase-MB was calculated in 123 (80%) patients. In 98 who r
eceived thrombolytic therapy the median time to peak enzyme release wa
s 15.5 h (7.5-24 h) in diabetic patients (n = 26) and 12 h (5-26 h) in
non-diabetic patients (n = 72) (p = 0.005). In those with a time to p
eak release of less than or equal to 12 h, indicating likely successfu
l reperfusion, PAI-1 activity was 17.5 (7.8) AU/ml compared with 22.8
(7.7) AU/ml in those with a time to peak release of >12 h (p = 0.001).
In multiple regression analysis both diabetes (p = 0.0001) and PAI-1
activity at admission (p = 0.029) were independently related to succes
sful reperfusion. In 13 patients with evidence of reinfarction in hosp
ital PAI-I activity on day 3 was 26.7 (6.4) AU/ml compared with 21 7 (
6 3) AU/ml in those without evidence of reinfarction (p = 0.032). Conc
lusion-Both raised PAI-1 activity on admission and diabetes were assoc
iated with a reduced likelihood of enzymatic evidence of reperfusion a
fter thrombolytic therapy. Increased PAI-1 activity on day 3 was assoc
iated with an increased risk of reinfarction. Diabetic patients had hi
gher PAI-1 activity on admission. This may partly explain their reduce
d likelihood of reperfusion.