The role of plasminogen activator inhibitor type 1 (PAI-1) in the development of thrombotic occlusions of the coronary arteries

   Myocardial infarction in most cases occurs as a result of a violation of the integrity of an atherosclerotic plaque. Plaque rupture leads to the initiation of the blood coagulation cascade, decreased blood flow, followed by vascular occlusion and myocardial necrosis. An increased risk of coronary heart disease and myocardial infarction is also associated with the activity of plasminogen activator inhibitor type 1 (PAI-1). In case of vascular injury, PAI-1 is involved in thrombus stabilization and wound healing processes. It also suppresses the fibrinolysis process, which is regulated by tissue plasminogen activator and urokinase thus blocking the conversion of plasminogen to plasmin. Elevated levels or excessive activity of PAI-1 may contribute to an increased risk of thrombotic events. This pattern is due to two main mechanisms: the formation of vulnerable plaques and a decrease in fibrinolysis.
   Objective. To analyze the literature on the clinical significance of PAI-1 in the development of thrombotic occlusions of the coronary arteries.
   Materials and methods. More than 150 scientific publications were studied. 35 literary sources were selected for analysis.
   Results. Clear literary data indicating the link of PAI-1 with cardiovascular diseases as independent factors of atherogenesis and thrombogenesis determine the interest in studying the role of PAI-1 in the development of myocardial infarction. The study of the 4G/5G polymorphism in the promoter region of PAI-1 may be of particular interest for explaining the pathophysiological mechanisms underlying myocardial infarction with ST segment elevation (STEMI) in young patients.
   Conclusion. The 4G/5G polymorphism in the promoter region of PAI-1 is an independent risk factor for myocardial infarction. Increased PAI-1 levels in vulnerable atherosclerotic plaques in young adults, associated with an enhanced inflammatory response, may contribute to the development of an atherothrombotic event. However, whether PAI-1 levels can significantly improve the prediction of cardiovascular risk remains an open question and requires further study.

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