Importance of thrombosis and thrombolysis in silent ischaemia: comparison of patients with acute myocardial infarction and unstable angina.

Abstract

The hallmark of unstable angina is its unpredictability. Studies using coronary arteriography, angioscopy, and serial reconstruction of the microanatomy all show that thrombosis at the site of ruptured plaque is important in the aetiology of unstable angina.' Episodes of silent ischaemia are more important than symptomatic ischaemia as contributors to total myocardial ischaemia burden. Around 70% of the ischaemic episodes in patients with coronary artery disease are not -associated with angina,2 but patients with exercise induced silent ischaemia have a similar prevalence of disease affecting the left main coronary artery and three main vessels to that, in patients with angina but a higher mortality.3Multivariate analyses showed that the presence of silent ischaemia in patients after admission to a coronary care unit was the best predictor of subsequent acute myocardial infarction or the need for angioplasty or bypass surgery.4 The prognostic importance of silent ischaemia in patients admitted to hospital with unstable angina prompted us to study the role of thrombotic and fibrinolytic process in these patients. Our goal was to determine whether these processes had a role in silent ischaemia detectable at rest but not induced by stress. Patients and methodsWe studied 10 healthy volunteers, 22

Nutritional leucine supplementation attenuates cardiac failure in tumour‐bearing cachectic animals

“…diseases and is valuable in predicting subsequent ischemic events. [55][56][57] In summary, the alterations observed in all three of the analysed biomarkers suggest that the untreated tumourbearing group (W) but not the leucine-treated group (LW) is more likely to experience heart damage that is currently linked to cancer-cachexia, such as fibrosis and atrophy, 9,11,12,58 as well as thrombosis and ischemia, which have not been investigated previously in studies of heart damage induced by cancer-cachexia.…”

“…Finally, functionally involved in the fibrinolysis system, the increased total PAI‐1 content that was observed only in untreated tumour‐bearing rats is not only an independent prognostic factor marker of heart failure after myocardial infarction but also indicates coronary and thrombolytic diseases and is valuable in predicting subsequent ischemic events …”

“…Another indicator that leucine might attenuate the processes that occur in the heart in response to cancer‐cachexia lies in the fact that we observed an increase in the area under the T‐wave amplitude, especially in the untreated group, which is typically associated with ischemia. We also observed a concomitant increase in MPO and total PAI‐1 expression in untreated tumour‐bearing rats; these two factors are involved in distinct pathways that can lead to ischemia …”

State-of-the-Art Review : Secondary Prevention of Myocardial Infarction: Beneficial Effect of Combining Oral Anticoagulant Plus Aspirin

“…As observed by Gurfinkel et al (17), clot lysis was a more active process in patients with unstable angina and silent ischemia than in those with AMI.…”

Supplementation of Virgin Coconut Oil Compared with Copra Oil, Olive Oil and Sunflower Oil on Thrombotic Factors in Rats and In Vitro Platelet Aggregation

“…Coronary thrombosis is a major cause of sudden cardiac death, acute myocardial infarction, unstable angina pectoris and silent myocardial ischaemia (Davies and Thomas, 1984;De Wood et al, 1980;Fuster and Chesebro, 1986;Gurfinkel et al, 1994). The thrombogenic state arises when an imbalance exists between procoagulant and profibrinolytic activity (Astrup, 1958;Nossel, 1998).…”