Fibrinolytic factors, serum lipid and C-reactive protein predicting cardiac events in Japanese patients with coronary atherosclerotic lesions

Although disturbances of the fibrinolytic system and serum lipid, and the p resence of inflammation, may be risk factors for coronary artery disease (C AD), few reports have investigated these relationships in Japanese patients . Data on 106 patients (79 men and 27 women, mean age 62.3 years) with athe rosclerotic lesions on the coronary angiogram were evaluated prospectively to identify whether the factors were useful in predicting the risk of coron ary events during a follow-up of 50+/-4 months. Of the 106 patients who wer e followed, 11 patients had coronary events (4 acute myocardial infarction and 7 unstable angina pectoris). In univariate Cox analyses, a high level o f tissue-plasminogen activator (t-PA), apolipoprotein CII, C-reactive prote in (CRP), and a low level of high density lipoprotein-cholesterol (HDL-C) w as each associated with a significant increase in the risk of future cardia c events. The stepwise model of Cox proportional hazards analysis selected only a high level of t-PA and CRP as predictors of cardiac events. Controll ing for any risk factor did not lower the relation between t-PA and the ris k of cardiac events, whereas the relative risk of cardiac events in CRP was not significant when controlled for HDL-C. Thus, in prospective data obtai ned from a cohort of Japanese patients with coronary atherosclerotic lesion s, the elevation of t-PA was an independent predictor of subsequent cardiac events. The prognostic role of CRP in cardiac events was related to a low level of HDL-C.