Acute Release of Plasminogen Activator Inhibitor-1 in ST-Segment Elevation Myocardial Infarction Predicts Mortality

Abstract

Background— A few studies have suggested that von Willebrand factor (vWF) or plasminogen activator inhibitor-1 (PAI-1) can be associated with outcomes of acute coronary syndromes. The present study was designed to assess the acute release of these markers in ST-segment elevation myocardial infarction (STEMI) and their relations to death. Methods and Results— In 153 consecutive patients with STEMI, vWF and PAI-1 antigens were measured on admission (H0) and 24 hours later (H24). At 30 days, the death rate was 7.2%. Heart failure (Killip stage ≥3) on admission was present in 13.7% of patients. The acute release of PAI-1 (H24−H0, in ng/mL) and of vWF (H24−H0, in %) was dramatically higher in patients who died than in those who survived (46.9±26.3 versus −0.6±2.8 ng/mL, P =0.0001 and 65.8±20.0% versus 10.0±5.1%, P =0.004 for PAI-1 and vWF, respectively) and in patients developing heart failure compared with those without (24.8±10.1 versus −1.1±3.3 ng/mL, P =0.004 and 47.3±11.0% versus 8.1±5.6%, P =0.005 for PAI-1 and vWF, respectively). The release of PAI-1 correlated weakly with the left ventricular ejection fraction ( R =−0.195, P =0.01) and the peak of troponin ( R =0.149, P =0.045). Postangioplasty TIMI-3 flow and the acute release of PAI-1 were the only 2 independent predictors of death at 30 days. Conclusions— The acute release of vWF and PAI-1 over the first 24 hours of STEMI is associated with death and heart failure. The acute rise of PAI-1 is also a strong independent predictor of death at 30 days.