Pretreatment Plasminogen Activator Inhibitor-1 (PAI-1) Level in the Failure of Streptokinase Therapy in Acute Myocardial Infaction

Abstract

Background: The risk for unsuccessful reperfusion after streptokinase therapy may be caused by the antifibrinolytic effect of platelet-derived type 1 plasminogen activator inhibitor (Pal-1) and antistreptokinase antibodies. This study aims to show the relation of pretreatment PAI-1 levels of patients with acute myocardial infarction treated with streptokinase and the outcome of fibrinolysis, emphasizing on reperfusion with and without considering pretreatment antistreptokinase antibodies. Methods: Pretreatment PAI-1 and antistreptokinase antibodies levels of 61 patients with acute myocardial infarction, treated with streptokinase, were determined by an enzyme- linked immunosorbent assay kit method. Failure of thrombolysis with streptokinase was present when reperfusion was unsuccessful as assessed by noninvasive reperfusion criteria. Results: Mean pretreatment PAI-1 level of patients was 29.72 ± 4.74 ng/ml. Thrombolysis with streptokinase failed significantly with higher pretreatment PAI-1 levels (p < 0.05) in all patients and patients with negative pretreatment antistreptokinase antibodies. Conclusion: We showed that higher on reperfusion in patients with acute myocardial infarction, with and without considering pretreatment antistreptokinase pretreatment PAI-1 levels were associated with significant failure of streptokinase therapy with the emphasis antibodies (anti-SK). It seems that by estimating PAI-1>25ng/l and antistreptokinase antibodies higher than normal levels in patients before the start of streptokinase therapy, candidates for potentially unsuccessful streptokinase therapy (with failed reperfusion) can be identified in advance and an alternative therapy such as primary angioplasty with better immediate results can be started.
Keywords: Plasminogen Activator Inhibitor, Streptokinase, Myocardial Infarction.