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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2000;20:1857.)
© 2000 American Heart Association, Inc.

Editorials

On the Association of Elevated tPA/PAI-1 Complex and von Willebrand Factor With Recurrent Myocardial Infarction

Henri Bounameaux; Egbert K. O. Kruithof

From the Division of Angiology and Hemostasis, Department of Internal Medicine, University Hospital of Geneva, Geneva, Switzerland.

Correspondence to Dr. H. Bounameaux, Division of Angiology and Hemostasis, Department of Internal Medicine, University Hospital of Geneva, Geneva, Switzerland. E-mail bounamea@cmu.unige.ch and Egbert.Kruithof@hcuge.ch

Key Words: Editorials • coronary heart disease • myocardial infarction • recurrence • risk factors • inflammation

For a long time, we have known that a decrease in fibrinolytic activity is linked to an increase in risk of myocardial infarction.^{1 2 3} Paradoxically, the most convincing association between fibrinolysis and cardiovascular risk was an increased level of the profibrinolytic enzyme itself, tissue plasminogen activator (tPA).^{4 5} This unexpected finding was said to be due to the methods of measurement, which were unable to distinguish free tPA from tPA complexed with various inhibitors, the most important one being plasminogen activator inhibitor 1 (PAI-1), but this explanation had never been proven.

Recently, specific 2-site ELISAs have been developed that allow independent measurements of complexes of tPA with its inhibitors PAI-1, C1'-inhibitor, and antiplasmin.⁶ In a substudy of the Stockholm Heart Epidemiology Program (SHEEP), Wiman and colleagues⁷ studied these particular components, as well as the more classic tPA and PAI-1 antigens, and PAI-1 activity in 1212 patients who were enrolled 3 months after a myocardial infarction. The results of this case-control study are reported in the present issue of the Journal (p 2020).

The baseline measurements of the variables of interest were compared with the recurrence rate of myocardial infarction during a follow-up of 3 years. These parameters were also compared with other variables that are either known or suspected to correlate with a recurrence of cardiac events, such as lipids, fibrinogen, and von Willebrand factor (vWF). Eighty-six patients of the cohort (7.1%; 95% confidence interval, 5.7% to 8.7%) experienced reinfarction. When compared with matched patients from the cohort and also with matched . . . [Full Text of this Article]

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