Risk stratification in patients with unstable angina and/or non-ST-elevation myocardial infarction by Troponin T and plasminogen-activator-inhibitor-1 (PAI-1)

Background: Increased Troponin T (TnT) and PAI-1 levels are markers of poor outcome in acute coronary syndromes (ACS). In order to stratify the risk for 30-day combined endpoint of mortality and/or reinfarction in unstable angina and/or non-ST-elevation myocardial infarction (UA/NSTEMI), TnT and PAI-1 levels were simultaneously assessed. Methods: The TnT and PAI-1 levels of 113 patients with UA/NSTEM were estimated within the first 48 h. Initial therapy was medical. Percutaneous coronary interventions were performed in case of recurrent ischemia and/or hemodynamic and/or rhythmic instability. Results: Statistically significant differences in mean admission PAI-1 (4.2 +/- 3.4 vs. 2.8 +/- 2.4 U/ml, p<0.05), mean peak PAI-1 levels within the first 48 h (4.98 +/- 3.1 vs. 3.4 +/- 2.5 U/ml, p<0.05), and no significant difference in any TnT level were observed between patients with and without 30-day mortality and/or reinfarction. The risk for 30-day mortality and/or reinfarction significantly increased in patients with admission PAI-1 levels > 4.0 U/ml (OR=4.44, 95%CI=1.47-13.4), peak PAI-1 levels>4.0 U/ml (OR=5.78, 95%CI=1.838-18.20) and with simultaneously increased peak PAI-1 > 3.5 U/ml and TnT > 0.1 mug/l within the first 48 h (OR=4.9, 95%CI=1.569-15.385). Conclusions: Simultaneous assessment of TnT and PAI-1 would provide complementary prognostic information and enable clinicians to stratify risk more effectively among patients with UA/ NSTEMI. (C) 2004 Elsevier Ltd. All rights reserved.