A critical review of the relationship between impaired fibrinolysis and myocardial infarction

To explore the relationship between impaired fibrinolysis and myocardial infarction, we conducted a literature search and reviewed the published data. The results indicate that myocardial infarction has a significant influence on fibrinolytic activity and that impaired fibrinolysis is more frequent in patients who have had a myocardial infarction than in healthy control subjects. Prospective cohort studies indicate that tests for global fibrinolytic activity are not of prognostic value for first or recurrent myocardial infarction. However, high levels of plasminogen activator inhibitor and low levels of tissue plasminogen activator activity were associated with an increased risk of reinfarction in survivors of a first myocardial infarction. Whether this relationship between impaired fibrinolysis and reinfarction is causal or coincidental is unclear. There is evidence that impairment of fibrinolytic activity is more marked in patients with myocardial infarction who have minimal coronary atherosclerosis than in those who have marked atherosclerosis, suggesting that impaired fibrinolytic activity might be of pathogenetic importance in this small subgroup of patients.