Patients with the lowest quartile of stimulated t-PA release had the highest rate of adverse cardiovascular events over 42 months (P=0.01).
Cohort (n=98)
Does endothelial fibrinolytic capacity predict future adverse cardiovascular events in patients with stable coronary heart disease?
Endothelial fibrinolytic capacity, measured by stimulated t-PA release, is a powerful predictor of future adverse cardiovascular events in patients with stable coronary heart disease.
p-value: p=0.01
OBJECTIVE: The endothelium-derived fibrinolytic factor tissue plasminogen activator (t-PA) is a major determinant of vessel patency after coronary plaque rupture and thrombosis. We assessed whether endothelial fibrinolytic capacity predicts atherothrombotic events in patients with coronary heart disease. METHODS AND RESULTS: Plasma t-PA and plasminogen activator inhibitor (PAI)-1 concentrations were measured during intrabrachial substance P infusion in 98 patients with angiographically proven stable coronary heart disease. Forearm blood flow was measured during infusion of substance P and sodium nitroprusside. Cardiovascular events (cardiovascular death, myocardial infarction MI, ischemic stroke CVA, and emergency hospitalization for unstable angina) were determined during 42 months of follow-up. Patients experiencing a cardiovascular event (n=19) had similar baseline characteristics to those free of events. Substance P caused a dose-dependent increase in plasma t-PA concentrations (P<0.001). However, net t-PA release was 72% lower in the patients who experienced death, MI, or CVA, and 48% lower in those who suffered death, MI, CVA or hospitalization for unstable angina (P<0.05). Major adverse cardiovascular events were most frequent in those with the lowest fibrinolytic capacity (P=0.03 for trend); patients with the lowest quartile of t-PA release had the highest rate of adverse events (P=0.01). CONCLUSION: Endothelial fibrinolytic capacity, as measured by stimulated t-PA release, predicts the future risk of adverse cardiovascular events in patients with coronary heart disease. We suggest that endothelial fibrinolytic capacity is a powerful novel determinant of cardiovascular risk.
Robinson et al. (Fri,) conducted a cohort in stable coronary heart disease (n=98). Endothelial fibrinolytic capacity (stimulated t-PA release) vs. Higher fibrinolytic capacity was evaluated on Cardiovascular events (cardiovascular death, myocardial infarction, ischemic stroke, and emergency hospitalization for unstable angina) (p=0.01). Patients with the lowest quartile of stimulated t-PA release had the highest rate of adverse cardiovascular events over 42 months (P=0.01).