IMPAIRMENT OF PLASMA FIBRINOLYSIS IN YOUNG SURVIVORS OF MYOCARDIAL-INFARCTION WITH SILENT ISCHEMIA

The aim of this study was to compare fibrinolytic parameters in two su bgroups of young survivors of myocardial infarction: group A (n = 14) with silent myocardial ischaemia and group B (n = 15) without silent m yocardial ischaemia, as assessed by 24 h Holter electrocardiogram moni toring. Only men aged 33-46 years who were in a stable condition at le ast 6 months after the acute event were included in the survey. All pa tients were normolipaemic or had only mild hyperlipidaemia, non-diabet ic, normotensive, non-current smokers and with a normal body mass inde x. The control group consisted of 15 age-matched healthy men. Blood sa mples were taken at 7.30 a.m. In the group A patients, we found higher mean levels of tissue plasminogen activator (t-PA) total antigen (11. 1 versus 6.9 ng/ml, P < 0.01), its inhibitor plasminogen activator inh ibitor-1 (PAI-1) antigen (58.1 versus 34.8 ng/ml, P < 0.01), PAI-1 act ivity (4.9 versus 3.4 U/ml, P < 0.05) and tPA-PAI-1 complexes (5.1 ver sus 3.5 ng/ml, P < 0.05) as well as a lower level of t-PA activity (0. 5 versus 0.8 IU/ml, P < 0.01) and free t-PA antigen (0.8 versus 1.3 ng /ml, P < 0.01) compared with the controls. However, group A patients e xhibited higher PAI-1 antigen levels (58.1 versus 41.6 ng/ml, P < 0.05 ) than those without silent ischaemia. There were no differences betwe en group B and controls in any of the parameters measured. Our results indicate that patients with more severe disease, as revealed by silen t myocardial ischaemia, had lower levels of free t-PA as a result of t he excess of PAI-1. Blood Coag Fibrinol 9:245-249 (C) 1998 Lippincott- Raven Publishers.