Document Detail

Importance of thrombosis and thrombolysis in silent ischaemia: comparison of patients with acute myocardial infarction and unstable angina.
MedLine Citation:
PMID:  8130023     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To investigate whether plaque rupture and thrombosis have a role in silent ischaemia as well as in unstable angina. DESIGN: Prospective analysis of the results of haemostatic diagnostic tests at the moment of developing silent ischaemia at rest. SETTING: Coronary care unit. PATIENTS: 22 patients with acute myocardial infarction, 12 patients with symptomatic angina (unstable angina), and 10 normal volunteers (control group). INTERVENTIONS: Continuous cardiac monitoring detected 15 asymptomatic episodes (silent ischaemia) in 6 patients with unstable angina. Blood samples were obtained at admission and when an asymptomatic alteration was detected and 10 minutes later. MAIN OUTCOME MEASURES: Comparisons of concentrations of tissue plasminogen activator, urokinase type plasminogen activator, tissue plasminogen activator inhibitor-1, cross-linked fibrin degradation products, von Willebrand factor, and thrombin-antithrombin III complexes in patients and controls at admission; same comparisons in patients with silent ischaemia at the start of an episode and 10 minutes later. RESULTS: Tissue plasminogen activator concentrations were raised at admission in patients with acute myocardial infarction (mean (SD) 14.2 (6) ng/ml) and in patients with unstable angina (10.1 (2.5) ng/ml) in comparison with controls (5.1 (2.7) ng/ml, p < 0.01 and < 0.05 respectively). There was no differences between the two groups of patients, however. Similar results were observed at the start of a silent ischaemic episode (9.8 (1.9) ng/ml) and 10 minutes later (10.5 (2.9) ng/ml) compared with controls (p < 0.05). Tissue plasminogen activator inhibitor-1 concentrations were raised in patients with acute myocardial infarction (45.1 (15) ng/ml) compared with volunteers (20.6 (16) ng/ml, p < 0.01). In patients with silent ischaemia tissue plasminogen activator inhibitor-1 concentrations were slightly but not significantly increased. Concentrations of cross-linked fibrin degradation products (D dimer) increased during unstable angina (2150 (350) ng/ml) and silent ischaemia (2270 (450) ng/ml) compared with the concentrations in volunteers (340 (80) ng/ml) and patients with acute myocardial infarction (310 (120) ng/ml; p < 0.01). CONCLUSIONS: The results suggest that thrombosis mediates the pathophysiological mechanisms of silent ischaemia and unstable angina.
E Gurfinkel; R Altman; A Scazziota; J Rouvier; B Mautner
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  British heart journal     Volume:  71     ISSN:  0007-0769     ISO Abbreviation:  Br Heart J     Publication Date:  1994 Feb 
Date Detail:
Created Date:  1994-04-15     Completed Date:  1994-04-15     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0370634     Medline TA:  Br Heart J     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  151-5     Citation Subset:  AIM; IM    
Centro de Estudios Medicos y Bioquimicos, Buenos Aires, Argentina.
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MeSH Terms
Angina, Unstable / blood,  etiology*
Electrocardiography, Ambulatory
Fibrinolysis / physiology
Middle Aged
Myocardial Infarction / blood,  etiology*
Myocardial Ischemia / blood,  diagnosis,  etiology*
Plasminogen Activator Inhibitor 1 / blood
Prospective Studies
Thrombosis / blood,  complications*
Tissue Plasminogen Activator / blood
Reg. No./Substance:
0/Plasminogen Activator Inhibitor 1; EC Plasminogen Activator

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