Plasma lipoprotein (a) levels and fibrinolytic activity in acute myocardial infarction.

To evaluate the effects of lipoprotein (a) [Lp (a)] on the fibrinolytic system in patients with acute myocardial infarction (AMI) who underwent thrombolytic therapy with recombinant tissue-type plasminogen activator, we examined serial changes in plasma levels of Lp (a), plasminogen activator inhibitor (PAI) activity, alpha 2-plasmin inhibitor-plasmin complex (PIC) and thrombin antithrombin III complex (TAT) in venous plasma samples from 25 patients with AMI for 3 weeks. Plasma Lp (a) levels were significantly increased 5, 7, and 14 days after admission and tended to decrease by the 21st day. On the other hand, the ratio of PIC/TAT was significantly increased on the 7th day and remained high for 3 weeks (p < 0.01), while plasma PAI activity was significantly decreased on the 5th day after admission (p < 0.01). Thus, plasma fibrinolytic function is impaired in the early phase after AMI, and gradually improves over the course of 3 weeks. The increase in plasma Lp (a) levels is, therefore, not accompanied by a significant decrease in plasma fibrinolytic function in patients with AMI.