Abstract 13552: Clinical Relevance of Endogenous Tissue-plasminogen Activator in Patients With Aortic Valve Sclerosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ke Yang ◽  
Zhongli Chen ◽  
Ying Shen ◽  
Yangyang Zhang ◽  
Bo Wen Lin ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Plasminogen Activator ◽  
Clinical Outcomes ◽  
Tissue Plasminogen Activator ◽  
Area Under The Curve ◽  
Cardiovascular Death ◽  
Aortic Valves ◽  
Aortic Valve Sclerosis ◽  
Myocardium Infarction ◽  
Tissue Plasminogen

Introduction: Impaired fibrinolysis featuring elevated tissue plasminogen activator (t-PA) induces cardiovascular outcomes. Aortic valve sclerosis (AVSc) shares similar aspects of pathophysiology with atherosclerosis and correlates with adverse cardiovascular events. Hypothesis: We investigated whether endogenous t-PA is associated with AVSc and clinical outcomes of these patients. Methods: Plasma levels of t-PA were measured in 155 AVSc patients and 140 non-AVSc counterparts. The composite major adverse cardio-cerebral events (MACCE), including cardiovascular death, nonfatal myocardium infarction, stroke, and re-hospitalization because of heart failure or unplanned revascularization were recorded during follow-up in 143 patients with AVSc (median, 6.5 years). Expression of t-PA was detected in human aortic valves with and without sclerosis by immunochemical analysis. Results: Plasma t-PA was higher in patients with AVSc than in those without (median, 2163.10 pg/mL vs 1403.17 pg/mL, p < 0.001). After adjusting for confounding variables, t-PA level remained an independent risk factor for AVSc (OR=1.66, 95%CI: 1.18-2.34, P=0.004). Based on the optimal cut-off of 1787.8 pg/mL determined by X-tile program, AVSc patients with low t-PA displayed better survival free from MACCE than those with high t-PA (p=0.0018). After full adjustment, t-PA was independently associated with composite MACCE (HR=1.33, 95% CI: 1.07-1.66, p=0.009). The area under the curve of plasma t-PA for predicting composite MACCE within three years was 0.71(95%CI: 0.63-0.80). The expression of t-PA was three times higher in sclerotic compared to non-sclerotic aortic valves. Conclusions: Elevated endogenous t-PA in plasma may serve as an indicator of AVSc and is associated with poor clinical outcomes in patients with AVSc.

Abstract TP74: Early Administration of Tissue-plasminogen Activator Improves the Long-term Clinical Outcome at 5 Years After Onset

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Junya Aoki ◽  
Kazumi Kimura ◽  
Yuki Sakamoto
Keyword(s):  
Regression Analysis ◽  
Confidence Interval ◽  
Plasminogen Activator ◽  
Clinical Outcomes ◽  
Tissue Plasminogen Activator ◽  
Odds Ratio ◽  
Univariate Analysis ◽  
Favorable Outcome ◽  
Tissue Plasminogen

Introduction & Hypothesis: Data on long-term outcomes after tissue-plasminogen activator (tPA) therapy are limited. We evaluated the rate of favorable outcomes and mortality at 5 years after tPA therapy and investigated factors related to long-term clinical outcomes. Methods: Telephone interviews were used to assess the to the the modified Rankin Scale (mRS) scores at 3 months, 6 months, 1 year, 2 years, 3 years, 4 years, and 5 years after tPA therapy after written informed consent was obtained. When a telephone interview was not successfully accomplished, an interview letter was sent as an alternative method. Favorable outcome was defined as mRS 0-2, and unfavorable outcome was as mRS 3-6. Multivariate logistic regression analysis was conducted to investigate factors associated with favorable outcomes and mortality at 5 years after tPA therapy. Results: From 2005 to 2013, 256 (median age, 77 [interquartile range, 68-84] years; 157 [61%] males) patients were enrolled. The onset-to-treatment time (OTT) was 153 (120-176) minutes. At 3 months after tPA therapy, the median mRS score was assessed as 3 (1-5). Kaplan-Meier curve showed that favorable outcomes after 5 years after tPA therapy occurred in 45% patients and that the mortality rate was 40%. Univariate analysis showed that OTT was 123 (107-172) minutes in patients with favorable outcomes and 155 (124-172) minutes in patients with non-favorable outcomes (p=0.046). In addition, OTT was 157 (133-172) minutes in the death group and 123 (106-169) minutes in the survival group (p=0.001). Multivariate regression analysis indicated that OTT was an independent factor related to favorable outcomes (odds ratio 0.97, 95% confidence interval 0.95-0.99, p=0.008) and mortality (odds ratio 1.04, 95% confidence interval 1.02-1.06, p=0.001). Receiver operating characteristic curve analysis showed that OTT ≥ 136 minutes was the optimal cut-off value to predict favorable outcome at 5 years after tPA therapy, with a sensitivity of 0.67, a specificity of 0.70, and an area under curve (AUC) of 0.662 (p=0.016), and that to predict death within 5 years after tPA therapy, with a sensitivity of 0.70, a specificity of 0.66, and an AUC of 0.679 (p=0.001). Conclusion: Early tPA administration can improves long-term clinical outcomes.

scholarly journals Lack of Association between Hyperglycaemia at Arrival and Clinical Outcomes in Acute Stroke Patients Treated with Tissue Plasminogen Activator

2010 ◽  
Vol 5 (3) ◽  
pp. 163-166 ◽  
Author(s):  
William J. Meurer ◽  
Phillip A. Scott ◽  
Angela F. Caveney ◽  
Jennifer J. Majersik ◽  
Shirley M. Frederiksen ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Plasminogen Activator ◽  
Clinical Outcomes ◽  
Tissue Plasminogen Activator ◽  
Stroke Patients ◽  
Tissue Plasminogen

Abstract W P50: The Influence of Obesity on Outcomes After Intravenous Thrombolysis for Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Syed I Hussain ◽  
Adrienne V Nickles ◽  
Mat J Reeves
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Clinical Outcomes ◽  
Tissue Plasminogen Activator ◽  
Hospital Death ◽  
Obese Patients ◽  
Stroke Patients ◽  
Tissue Plasminogen ◽  
Tract Infections

Background: Current ASA guidelines do not recommend increasing the dose of intravenous tissue plasminogen activator (IV rt-PA) for acute ischemic stroke patients weighing >100 kg. However, the consequences of such potential under-dosing may mean that it is less effective or even less harmful. Objective: To determine the relationship between obesity and clinical outcomes among acute ischemic stroke patients receiving IV rt-PA. Methods: We identified patients who received IV recombinant tissue plasminogen activator (rt-PA) at 35 hospitals participating in the Michigan Coverdell Acute Stroke Registry from January2009 to December 2011. All ischemic strokes treated within 4.5 hours with non-missing BMI data were included in the analysis. Patient BMI was dichotomized as obese (BMI ≥30) or non-obese (BMI <30). Outcome measures included symptomatic intracerebral hemorrhage (sICH), in-hospital death, complications, length of stay (LOS) and discharge to home. The independent effects of obesity on outcomes were analyzed using logistic regression analysis with adjustment for age, gender, race and medical history. Results: Of 698 AIS patients who received IV rt-PA 536 (76.7%) had information on BMI recorded. Among those, 263 (37.7%) were obese. Compared to non-obese patients, obese patients were more likely to be women (57.8% vs. 44.6% p=0.0007), be younger (mean age 64.0 vs. 69.7 p<0.0001), and have hypertension and diabetes mellitus. Obese patients had longer LOS (mean 7.0 vs. 5.8 days, p=0.009) and were more likely to develop urinary tract infections (6.3 % vs. 11.3 %; p=0.009). In a multivariate regression model adjusting for age, gender, race medical comorbidities, obese to non-obese patients rates of sICH (OR, 95% CI 1.2 (0.47- 3.2), p= 0.68, death [OR, 95% CI 1.2 (0.56- 2.8),p=0.60] and discharge to home [OR, 95% CI 1.0 (0.69- 1.5), p=0.89)were all similar. Conclusion: Obese patients receiving IV t-PA treatment for acute ischemic stroke had similar rates of in-hospital mortality, discharge to home and sICH, but they had longer LOS and rates of UTI. Future studies should be undertaken to determine if the clinical efficacy of tPA is affected by under-dosing focusing on both radiographic recanalization rates and functional clinical outcomes.

Correlation between Baseline Plasminogen Activator Inhibitor Levels and Clinical Outcome during Therapy with Tissue Plasminogen Activator for Acute Myocardial Infarction

1991 ◽  
Vol 65 (03) ◽  
pp. 275-279 ◽  
Author(s):  
David C Sane ◽  
David C Stump ◽  
Eric J Topol ◽  
Kristina N Sigmon ◽  
Dean J Kereiakes ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Plasminogen Activator ◽  
Clinical Outcomes ◽  
Tissue Plasminogen Activator ◽  
Plasminogen Activator Inhibitor ◽  
Post Discharge ◽  
Tissue Plasminogen ◽  
Activator Inhibitor ◽  
Pai 1

SummaryBaseline plasminogen activator inhibitor (PAI) levels were examined for their influence on the responses to thrombolysis with recombinant tissue plasminogen activator (rt-PA) administered for acute myocardial infarction during the Thrombolysis and Myocardial Infarction (TAMI)-I study. Baseline PAI activity was 19 ± 21 IU/ml (normal <5 IU/ml) and baseline PAI-1 antigen 54 ± 53 ng/ml (normal 27 ± 16 ng/ml), confirming previous findings of elevated PAI levels during acute myocardial infarction. Among clinical outcomes, lower PAI-1 antigen levels correlated weakly with greater patency at the 90 min angiogram. Thus, high baseline plasma PAI-1 levels may be detrimental to reperfusion with t-PA. There was no correlation with other major in-hospital clinical outcomes including reocclusion at the 7-10 day angiogram, survival to discharge, or bleeding. During the follow up period of 2.0 ± 0.4 years, no relationship between baseline PAI levels and post-discharge reinfarction was observed.

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