Plasmin-antiplasmin complexes in prognostic evaluation of patients with unstable angina

Introduction. Unstable angina (UA) is characterised by recurrent ischemic episodes over a period of months and weeks. There are several lines of evidence suggesting that thrombus generation in UA is a transient phenomenon. However, there are few data linking the hemostatic and fibrinolytic systems to short term prognosis. To assess whether activation of the fibrinolytic system is related to prognosis we measured α2-antiplasmin-plasmin complexes (APP) levels in 21 patients admitted to our Coronary Care Unit for UA. Mean age was 54 ± 12. A blood sample was taken as soon as possible after patient admission to the CCU. We considered major and minor coronary events in the hospital follow-up. Major coronary events were defined as acute myocardial infarction (AMI) or cardiac death; minor events were urgent coronary angioplasty (PTCA) or coronary artery by-pass grafting (CABG), because of failure of full medical therapy to control ischemic episodes. Results. All patients presented with severe rest angina; 6 21 patients had spontaneous remission of UA with medical therapy (G1), but 15 (G2) had a worsening, requiring CABG (9), or PTCA (4); 3 G2 patients developed an AMI within 10 days after admission, and 1 patient died after CABG. The G2 patients experienced 100 episodes of recurrent angina during the study period (6.6 ± 3.6 per patient), significantly more than Gl patients (2.5 ± 3.8 per patient, p < 0.05). APP values on admission were significantly higher (p < 0.05) in G2 (580 μl/l;; range 227-1730) vs. G1 (305 μl/l; range 230-500). Conclusions. Our study demonstrates an association between levels of APP and short term prognosis in UA. © 1994.