ENALAPRIL RELATED CHANGES IN THE FIBRINOLYTIC SYSTEM IN SURVIVORS OF MYOCARDIAL-INFARCTION

Disturbances of the fibrinolytic system have been associated with card iovascular disease and its risk factors. In the present study the effe cts of an ACE-inhibitor (enalapril) and a placebo on the fibrinolytic system have been compared. Eighty one survivors of acute myocardial in farction were randomised to treatment with enalapril or placebo. The m ass concentrations and activity of tissue plasminogen activator (tPA) and plasminogen activator inhibitor (PAI-1) in plasma were measured th ree months after the infarction. The enalapril group had a significant ly lower level of tPA antigen compared to the placebo-treated group (9 .2 and 10.6 respectively). There was no difference between the two gro ups in any of the other fibrinolytic variables. We conclude that survi vors of myocardial infarction treated with enalapril have a significan tly lower concentration of tPA antigen than those treated with placebo . This may have a prognostic implication, as lower plasma concentratio ns of tPA antigen have been associated with better prognosis in patien ts with established coronary heart disease.