Plasminogen Activator Inhibitor-1 and the Calculus of Mortality After Myocardial Infarction

There are numerous clinical factors that have beenidentified that are associated with an adverse outcomeafter acute myocardial infarction (MI). These factors include female gender, the presence of severe left ventricular dysfunction or congestive heart failure, a history of diabetes mellitus, age 70 years, infarct location (anterior versus inferior), and patency of the infarct-related artery. In this issue of Circulation, Collet and colleagues1 describe a previ-ously unrecognized relationship between acute increases in plasma levels of plasminogen activator inhibitor-1 (PAI-1) in patients hospitalized with acute ST-elevation MI and risk of mortality during a 1-month period. See p 391 PAI-1 is the primary circulating inhibitor of tissue-type plasminogen activator and the urokinase-type plasminogen activator in plasma. Elevated plasma PAI-1 levels have been shown to be a predictor of recurrent MI2 and have been