PAI-1 4G/5G gene polymorphism is associated with angiographic patency in ST-elevation myocardial infarction patients treated with thrombolytic therapy

Abstract

Background 

In this study, we examined the relationship between PAI-1 4G/5G polymorphism and patency of the infarct-related artery after thrombolysis in patients with ST-elevation myocardial infarction (STEMI).

Methods 

Acute STEMI patients who received thrombolytic therapy within first 12 h were included in our study. The PAI-1 4G/5G promoter region insertion/deletion polymorphism was studied from venous blood samples. Patients with the PAI-1 4G/5G gene polymorphism were included in group 1 and the others were included in group 2. Coronary angiography was performed in all patients in the first 24 h after receiving thrombolytic therapy. Thrombolysis in myocardial infarction (TIMI) 0–1 flow in the infarct-related artery was considered as ‘no flow’, TIMI 2 flow as ‘slow flow’, and TIMI 3 flow as ‘normal flow’.

Results 

A total of 61 patients were included in our study. Thirty patients (49.2%) were positive for the PAI-1 4G/5G gene polymorphism, whereas 31 of them (50.8%) were in the control group. There were significantly more patients with ‘no flow’ (14 vs. 6; P=0.02) and less patients with ‘normal flow’ (8 vs. 19; P=0.02) in group 1. In addition, time to thrombolytic therapy (TTT) was maximum in the ‘no flow’ group and minimum in the ‘normal flow’ group (P=0.005). In the logistic regression analysis, TTT (odds ratio: 0.9898; 95% confidence interval: 0.982–0.997; P=0.004) and the PAI-1 4G/5G gene polymorphism (odds ratio: 4.621; 95% confidence interval: 1.399–15.268; P<0.01) were found to be independently associated with post-thrombolytic ‘no flow’.

Conclusion 

The PAI-1 4G/5G gene polymorphism and TTT are associated independently with ‘no flow’ after thrombolysis in patients with STEMI.