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Prognostic value of plasminogen activator inhibitor-1 on long term outcome in patients with acute myocardial infaction with ST elevation treated with primary percutaneous coronary intervention ; Clinical Medical Sciences - Research Proposal

Introduction. Cardiovascular diseases are the main cause of death in Croatia. In 2012 coronary artery disease was the most common cause of death. Acute myocardial infarction is the most severe form of coronary artery disease. Contemporary treatment of eligible patients includes primary percutaneous coronary intervention (PCI). Plasminogen activator inhibitor-1 (PAI-1) is the main inhibitor of plasminogen activation. It is secreted by endothelial cells and platelets, and in some circumstances by other cells. By reviewing recent data, no reference on PAI-1 value in prediction of long-term outcome for patients with acute myocardial infarction treated with primary percutaneous coronary intervention could be found. Hypothesis: 1. In acute St elevation myocardial infarction (STEMI)patients, PAI-1 correlates with infarction size measured by peak creatine phosphokinase (CPK)level. 2. PAI-1 is elevated in acute STEMI patients treated with primary PCI in whom "slow flow" phenomenon is observed after succesfull recanalisation of coronary artery with culprit lesion. 3. In acute STEMI patients, PAI-1 measured in acute phase predicts long-term (six months and 4 years)outcome (death, acute coronary syndroem, and stroke). Aims: 1. To determine correlation between peak CPK as a surrogate marker of infarction size and PAI-1 dinamics in acute STEMI patients treated with primary PCI. 2. To determine correlation between PAI-1 dinamics and presence to "slow-flow" phenomenon in acute STEMI patients with successfully recanalised coronary artery with culprit lesion. 3. To determine predictive value of PAI-1 measured in acute phase of STEMI on long term outcome. Materials and methods: Patients treated with primary PCI for acute STEMI were included in the study, while those with altered immune response due to medical treatment, acute inflamatory illness or malignancy were excluded. PAI-1 activity was determined at arrival and after 24 hours. CPK levels were determined every 6 hours until drop. Outcomes were determined by telephone interview. Expected scientific contribution: This study will help elucidate the potential patophysiologic role of PAI-1 in "slow-flow" phenomenon. If proven to correlate with incidence of "slow-flow", it could serve as potential treatment target in future. Predictive value of PAI-1 in acute STEMI patients treated with primary PCI is not established. With this study more clear insight on significance of measuring PAI-1 in acute STEMI patients and its role in predicting long term outcome will be determined. Poster code: B-9-43

plasminogen activator inhibitor-1; acute myocardial infarction; primary percuteneous coronary intervention; long term outcome; no reflow phenomenon

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