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Alexander Niessner, Senta Graf, Mariam Nikfardjam, Walter S. Speidl, Renate Huber-Beckmann, Gerlinde Zorn, Johann Wojta, Kurt Huber
Circulating t-PA antigen predicts major adverse coronary events in patients with stable coronary artery disease a 13-year follow-up
Thrombus formation after rupture of an atherosclerotic plaque plays a crucial role in coronary artery disease (CAD). A decreased endogenous fibrinolytic system and prothrombotic factors are supposed to influence coronary thrombosis. It was our aim to investigate the predictive value of tissue plasminogen activator (t-PA) antigen, von Willebrand Factor, Lipoprotein (a) and anti-cardiolipin antibodies for major adverse coronary events in patients with stable CAD in a prospective cohort study of more than 10 years. We observed 141 patients with angiographically proven CAD for a median follow-up period of 13 years. t-PA antigen was the only marker predicting coronary events (logistic regression, p = 0.044) with a poor prognosis for patients in the 5 th quintile with an odds ratio of 7.3 (compared to the 1 st quintile). The odds ratio even increased to 10.0 for coronary events associated with the natural course of CAD excluding events due to restenosis. t-PA antigen had a slightly higher prognostic power (ROC curve; AUC = 0.69) than fasting glucose (AUC = 0.68) and cholesterol (AUC = 0.67). Triglycerides influenced plasma levels of t-PA antigen (regression, p < 0.001). The predictive value of t-PA antigen remained significant after adjustment for inflammation (logistic regression, p = 0.013) and extent of CAD (p = 0.045) but disappeared adjusting for insulin resistance (p = 0.12). In conclusion t-PA antigen predicted coronary events during a very long-term follow-up with a comparable prognostic power to established cardiovascular risk factors. Markers of insulin resistance influenced t-PA antigen and its predictive value.
Thrombosis and Haemostasis, Schattauer
Print ISSN: 0340-6245
Volume: 90, 08/2003
Pages: 344 - 350