Prognostic role of tissue plasminogen activator in coronary artery disease with or without aortic valve sclerosis.

Abstract

We sought to investigate the relationship between circulating tissue plasminogen activator (t-PA) level and long-term outcomes in stable coronary artery disease patients with or without aortic valve sclerosis (AVSc). Serum levels of t-PA were determined in 347 consecutive stable angina patients with (n=183) or without (n=164) AVSc. Outcomes were prospectively recorded as planned clinic evaluations every 6months up to 7years. The primary endpoint was a composite of cardiovascular death and rehospitalization due to heart failure. The secondary endpoint included all-cause mortality, cardiovascular death, and rehospitalization due to heart failure. Serum t-PA was significantly higher in AVSc than in non-AVSc patients (2131.22pg/mL vs. 1495.85pg/mL, P<0.001). For patients with AVSc, those with t-PA level above the median (>1840.68pg/mL) were more likely to meet the primary and secondary endpoints (all P<0.001). After adjusting for potential confounding factors, serum t-PA level remained significantly predictive for each endpoint in the Cox proportional hazard models. The prognostic value of t-PA was good, with an AUC-ROC of 0.753 (P<0.001). The combination of t-PA with traditional risk factors improved the risk reclassification of AVSc patients, with a net reclassification index of 0.857 and an integrated discrimination improvement of 0.217 (all P<0.001). However, for patients without AVSc, both primary and secondary endpoints were similar, irrespective of t-PA levels. Elevated circulating t-PA confers an increased risk for poor long-term clinical outcomes in stable coronary artery disease patients with AVSc.