الفهرس 
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Abstract
• Introduction: There are many risk factors for ACS. So, comprehensive understanding of the pathophysiology and identifying the risk factors, as well as exploring novel predisposing risk factors for ACS has become crucial for the proper prevention and treatment of ACS. Blood flow is maintained by proper balance between pro coagulant and anticoagulant systems. The process of blood coagulation is maintained by proper boalnce between pro coagulant and anticoagulant systems. Protein Z act as a cofactor Protein Z dependent protease inhibitor (ZPI) (member of anticoagulant system) to inhibit activated factor X (FXa) in presence of ca+2 and phospholipids. • Aim of the work: The aim of the study is to evaluate plasma PZ level as a risk factor for Acute Coronary Syndrome in Egyptian patients. • Subjects and methods: The study was case control and was conducted at Specialized Medical Hospital, Mansoura University. The study included 30 ACS patients at admission (group A), 30 ischemic patients with history of ACS from 3 months and were asymptomatic during this period (group B) and 30 normal individuals as control (group C). All selected patients were subjected to history taking and physical examination. Blood samples were collected for CBC, liver functions, kidney function, lipid profile, cardiac enzymes (Troponin and CKMB) and protein Z assay. Other investigations as ECG, coronary angiography and echocardiography are also performed. Results: The study found statistical significance of low PZ levels in ACS patients either acute or stable compared to control subjects (p<0.001) & (p=0.008) respectively. However, no statistical significance was found in acute compared to stable phase (p=0.3). The study also revealed low PZ level in smokers in acute and stable groups (p=0.001) & (p=0,036) respectively as well as in hypertensive patients in both groups (p=0.04) & (p=0.03) respectively. Conclusion: Low PZ levels are significantly associated with occurrence of ACS and even in the stable phase of activity of ACS. In conclusion, low plasma PZ level is a risk factor for ACS.