ABSTRACT
The mechanism leading to ischemia in many patients with effort angina is an increase in their oxygen demand due to restriction of myocardial oxygen supply through a fixed obstructive coronary artery. The recognition of clinical markers indicating present disease status and predicting an early unfavorable outcome is of paramount importance in defining management strategies. Compared to normal subjects, a reduction of tissue plasminogen activator (t-PA) release and high plasminogen activator inhibitor-1 (PAI-1) activity or antigen in patients with fixed obstructive coronary artery thrombosis has already been documented. Considering the behavior of the fibrinolytic components during exercise, fibrinolytic capacity is enhanced because of t-PA release and PAI-1 reduction, even when ischemia is provoked by exercise. PAI-1 screening may be most useful in identifying patients at risk and allow prevention of acute ischemic events and their complications by early coronary intervention or through the use of suitable drugs.
