FIBRINOLYTIC VARIABLES AND CARDIOVASCULAR PROGNOSIS IN PATIENTS WITH STABLE ANGINA-PECTORIS TREATED WITH VERAPAMIL OR METOPROLOL - RESULTS FROM THE ANGINA PROGNOSIS STUDY IN STOCKHOLM

Background Disturbed fibrinolytic function may influence the progressi on of coronary atherosclerosis and contribute to thrombotic cardiovasc ular (CV) events. Methods and Results In the Angina Prognosis Study In Stockholm (APSIS), patients with stable angina pectoris were studied prospectively during double-blind treatment with metoprolol or verapam il. Various measures of fibrinolytic function were studied in 631 (of 809) patients. During a median follow-up time of 3.2 years (2132 patie nt-years), 32 patients suffered a CV death, 21 had a nonfatal myocardi al infarction (MI), and 77 underwent revascularization. Plasma levels of tissue plasminogen activator (TPA) activity and antigen tag), plasm inogen activator inhibitor (PAI-1) activity at rest, and TPA responses to exercise were determined at baseline and after 1 month's treatment and were related to subsequent fatal and nonfatal CV events. Univaria te Cox regression analysis revealed that elevated levels of TPA-ag at rest (P<.05), high PAI-1 activity (P<.05), and low TPA-ag responses to exercise (P<.05) were associated with increased risk of subsequent CV death. After adjustment for baseline risk factors, TPA-ag independent ly predicted CV death or MI. In addition, PAI-1 activity independently predicted CV death or MI in male patients. Verapamil treatment was as sociated with a 10% decrease of TPA-ag levels and metoprolol treatment with a 2% increase (P<.001 for treatment difference). Conclusions Pla sma TPA-ag levels at rest, and among male patients PAI-1 activity as w ell, independently predict subsequent CV death or MI in patients with stable angina pectoris. Impaired fibrinolytic reactivity to exercise i s a novel factor related to CV prognosis. Effects of verapamil or meto prolol treatment on fibrinolytic function did not importantly influenc e CV prognosis.