The effect of high plasma levels of angiotensin-converting enzyme (ACE) and plasminogen activator inhibitor (PAI-1) on the reperfusion after thrombolytic therapy in patients presented with acute myocardial infarction |
| |
Authors: | El Menyar Ayman A Altamimi O M Gomaa Mohamed M Fawzy Zainab Rahman M O Abdel Bener Abdulbari |
| |
Institution: | (1) Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar;(2) Department of Department Laboratory Medicine and Pathology, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar;(3) Department of Medical Statistics & Epidemiology, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar;(4) Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital, P.O. Box 3050, Doha, State of Qatar |
| |
Abstract: | The resistance to thrombolytic agents and delays in reperfusion occur in more than 30% after acute myocardial infarction.
This may play an important role in the unsuccessful recanalization after thrombolytic therapy. The aim of this study is to
assess the clinical and biochemical markers of reperfusion after different types of thrombolytic therapy and to find out the
relationship between PAI-1 and ACE serum levels and the short-term outcome. Pretreatment ACE and PAI-1 plasma levels of 184
patients with acute myocardial infarction, treated with thrombolytic therapy were determined. Failure of thrombolysis was
considered when reperfusion was delayed as assessed by noninvasive reperfusion criteria, reinfarction, and impaired left ventricular
function. High plasma level of ACE (> 50 U/L), PAI-1 (> 43 ng/ml) and both was found in 57, 108 and 32 patients respectively.
Subjects with high ACE plasma levels were characterized by impaired LV systolic function (79.0% vs. 75.0%), new Q-wave (88.4%
vs. 74.2%), less reperfusion arrhythmia (19.3% vs. 22.8%) and prolonged hospitalization (70% vs. 66%) but no statistical significance
was observed. High enzymes levels of PAI-1 were observed with higher incidence of anterior myocardial infarction (50.0% vs.
41.0%), lesser ST segment resolution (65.6% vs. 58.8%), reinfarction (6.3% vs. 5.9%), and impaired LV systolic function (90.6%
vs. 76.0%), and prolonged hospitalization (70.4% vs. 63.4). There was a statistically significant difference between thrombolytic
agents in the presence of high ACE regarding hospital overstay (p = 0.02). While the presence of high PAI-1 was significantly affect the degree of ST-segment resolution (p = 0.03).
Conclusion: High plasma ACE and/or PAI-1 plays a considerable role in the higher incidence of unsuccessful reperfusion and impaired
left ventricular function after thrombolytic therapy. A rapid diagnostic tool that enables physician of detecting those enzymes
before giving thrombolytic therapy may change the strategy of treatment to offer another effective revascularization method. |
| |
Keywords: | angiotensin converting enzyme Plasminogen activator inhibitor reperfusion thrombolysis myocardial infarction |
本文献已被 PubMed SpringerLink 等数据库收录! |
|