Abstract
Objective: To compare levels of tissue plasminogen activator and plasminogen activator inhibitor-1 levels in patients with acute myocardial infarction and unstable angina in order to understand the use of high sensitivity C-reactive protein (hsCRP), coagulation and fibrinolysis markers for cardiovascular risk assessment.
Methods: The cross-sectional case-control study compared circulating concentrations of high sensitivity C reactive protein (hsCRP), fibrinogen, tissue-type plasminogen activator (tPA), and plasminogen activator inhibitor-1 (PAI-1) between patients of acute myocardial infarction (AMI) (n = 67), Unstable Angina Pectoris (UA) (n = 35) and healthy control subjects (n = 39) at the King Khalid University Hospital, Riyadh, Saudi Arabia, from June 2006 to August 2007.
Results: The patients had significantly higher hsCRP (1.06 +/- 0.11 vs 0.52 +/- 0.14, p<0.01), fibrinogen (426.21 +/- 24.09 vs 329.32 +/- 13.93, p<0.05), PAI-1 (44.02 +/- 6.05 vs 19.35 +/- 3.94, p<0.01) and tPA (12.31 +/- 1.16 vs 9.49 +/- 0.86, p<0.05) compared to the controls. Fibrinogen (329.32 +/- 13.93) and PAI-1 (19.35 +/- 3.94) were higher in both angina and infarction groups compared to the healthy subjects (p<0.01). Between the two categories of patients the difference between Fibrinogen (449.60 +/- 52.98 vs 419.46 +/- 23.42) and PAI-1 (52.00 +/- 17.34 vs 43.19 +/- 6.10) levels were non-significant. Also, the difference in tPA levels between the controls and angina patients was non-significant (9.49 +/- 0.86 vs 9.91 +/- 1.24 p>0.05). It was higher in infarction patients (14.79 +/- 3.14) compared to angina patients and the controls, (p<0.05). Compared to the controls, hsCRP levels were significantly higher in both the patient groups (0.52 +/- 0.14, 1.05 +/- 0.28, 1.40 +/- 0.20, p<0.01). Moreover, they were significantly higher in infarction patients than those suffering from angina (p<0.05).
Conclusions: CAD patients had a procoagulant state and presented with higher levels of hsCRP compared to the healthy individuals. Moreover, there were significant differences in coagulation markers and hsCRP between angina and infarction patients.