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J Am Coll Cardiol, 2005; 45:30-34, doi:10.1016/j.jacc.2004.09.052
© 2005 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: ATHEROTHROMBOSIS

An increase of C-reactive protein is associated with enhanced activation of endogenous fibrinolysis at baseline but an impaired endothelial fibrinolytic response after venous occlusion

Walter Stefan Speidl, MD*, Andrea Zeiner, MD{dagger}, Mariam Nikfardjam, MD*, Alexander Geppert, MD{ddagger}, Nelli Jordanova, MD{ddagger}, Alexander Niessner, MD*, Gerlinde Zorn, BSc*, Gerald Maurer, MD, FACC*, Wolfgang Schreiber, MD{dagger}, Johann Wojta, PhD* and Kurt Huber, MD, FACC{ddagger},*

* Department of Internal Medicine II, Medical University of Vienna and the Ludwig Boltzmann Foundation for Cardiovascular Research, Vienna, Austria
{dagger} Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
{ddagger} 3rd Department of Medicine (Cardiology and Emergency Medicine), Wilhelminenspital, Vienna, Austria

Manuscript received May 25, 2004; revised manuscript received September 20, 2004, accepted September 21, 2004.

* Reprint requests and correspondence: Dr. Kurt Huber, 3rd Department of Medicine, Wilhelminenspital, Montlearstr. 37, A-1171 Wien, Austria (Email: kurt.huber{at}meduniwien.ac.at).

OBJECTIVES: The goal of this study was to determine whether chronic inflammation of the vascular wall may be associated with an impaired activation of the fibrinolytic system.

BACKGROUND: Inflammation plays an important role in the initiation and progression of atherosclerosis, and the fibrinolytic system may prevent local thrombus formation.

METHODS: We included 50 patients six months after their first myocardial infarction. Plasma levels of the inflammatory marker C-reactive protein (CRP) were determined at basal conditions, and the fibrinolytic parameters tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor type-1 (PAI-1) were measured at basal conditions and after a standardized venous occlusion (VO) of the forearm.

RESULTS: Patients with high CRP levels (≥3 mg/l) showed a significantly higher t-PA activity at baseline compared with patients with medium (1 to 2.9 mg/l) and low (<1 mg/l) CRP levels (p < 0.005). In contrast, patients with low CRP levels showed a higher increase of t-PA activity (p < 0.05) and a higher reduction of PAI-1 activity during VO (p < 0.05) compared with patients with medium and high CRP levels. A multivariate analysis that included cardiovascular risk factors and medical treatment showed that CRP is an independent predictor of the t-PA response after a standardized VO.

CONCLUSIONS: Chronic low-grade inflammation is associated with enhanced activation of endogenous fibrinolysis at baseline but a reduced fibrinolytic response to VO. This impaired endogenous fibrinolytic capacity might be an important contributor to the increased coronary event rate associated with elevated CRP levels.

Abbreviations and Acronyms
  CRP = C-reactive protein
  F1+2 = prothrombin fragment F1+2
  PAI-1 = plasminogen activator inhibitor type-1
  sICAM-1 = soluble intercellular cell adhesion molecule-1
  STEMI = ST-segment elevation myocardial infarction
  TNF = tumor necrosis factor
  t-PA = tissue-type plasminogen activator
  VO = venous occlusion




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