Predictive role of plasminogen-activator-inhibitor-1 (PAI-1) in non-ST-segment elevation acute coronary syndrome

Background

Increased plasma activity of plasminogen-activator-inhibitor-1 (PAI-1) is associated with increased risk for coronary thrombosis, but its role in predicting adverse events in non-ST-segment elevation acute coronary syndrome (ACS) is not yet defined. Therefore, we studied prospectively the role of PAI-1 activity for the 30-days composite endpoint of death and new myocardial infarction (MI) in patients with ACS.

Methods

Fifty-one patients with chest discomfort, but no ST-segment elevation on ECG were admitted to the ICU. PAI-1 levels were estimated at admission and every 12 hours in the first 48 hours by chromogenic method (normal range 0.5–3.5 U/ml), as well as Troponin T (TnT) by electrochemiluminescence immuno method at admission and 8 hours later (normal level up to 0.1 μg/l). After initial medical therapy, in case of recurrent ischemia and/or haemodynamic and/or rhythmic instability, percutaneous interventions (PCI) were performed. Thirty-days mortality and new MI were registered.

Results

The composite 30-days endpoint of mortality and/or new MI was 13.1% (7/51). Between patients with and without composite death and/or new MI statistically significant difference was observed in mean admission PAI-1 levels (5.3 ± 4.2 vs 3.0 ± 2.4 U/ml, P < 0.05), highest mean PAI-1 levels in the first 48 hours (5.98 ± 4.1 vs 3.2 ± 2.4 U/ml, P < 0.05), mean ICU stay (7.8 ± 7.0 vs 3.1 ± 1.4 days, P < 0.001), but nonsignificant difference in mean admission TnT (0.5 ± 0.7 vs 0.4 ± 7.3 μg/l, P > 0.05) and highest in-hospital TnT levels (1.4 ± 1.8 vs 0.9 ± 1.5 μg/l, P > 0.05). The risk for 30-days mortality and/or new MI was significantly increased only in patients with PAI-1 levels over 5.0 U/ml in the first 48 hours of therapy (OR 17.5, 95% CI 2.05–149.1).

Conclusions

PAI-1 level > 5.0 U/ml during first 48 hours of therapy was the only significant risk for composite 30-days death and/or new MI of patients with non-ST-segment elevation ACS.