Buckground: The antitibrinolytic effect of plasminogen-activator-inhibitor type 1 (PAI-1) may be responsible for delays in reperfusion and/or reinfarctions after streptokinase (STK) therapy in patients with acute myocardial infarction (AMI). Hyporhesis: This study aimed to demonstrate the prognostic role of pretreatment PAI-1 levels for the outcome of STK therapy in patients with AMI, depending on reperfusion and/ or reinfarction. Methods: The mean pretreatment PAL1 level of 104 patients with

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... I, treated with STK, determined by chromogenic method, was 5.8 k 8.6 U/ml, range 0.3-66.2 U/ml. Streptokinase therapy was successful when reperfusion was achieved, as assessed noninvasively, wi@out subsequent reinfarction; it failed when reperfusion was delayed & / o r reinfarction developed. Results: Fibrinolysis with STK failed significantly in patients with elevated pretreatment PAIl levels (p < 0.05), especially with levels > 4.0 U/ml (p < 0.01). The mean pretreatment PAL 1 level was significantly higher in unsuccessfully treated patients. Multivariate statistical testing demonstrated that among pretreatment variables, elevated PAI-1 activity was the most significant independent risk factor of failed fibrinolysis with STK. Conclusions: Among pretreatment variables, elevated pretreatment PAI-1 activity in patients with AM1 was the most significant independent risk factor of failed fibrinolysis with STK, especially at levels >4.0 U/ml.