Circulation, Vol 82, 2052-2060, Copyright © 1990 by American Heart Association
G Schieman, BM Cohen, J Kozina, JS Erickson, RA Podolin, KL Peterson, J Ross Jr and M Buchbinder
Intracoronary urokinase was used to treat flow-limiting intracoronary
thrombus accumulation that complicated successful percutaneous transluminal
coronary angioplasty (PTCA) during acute ischemic syndromes in 48 patients
who were followed up through the acute phase of their illness. The study
group comprised 10 patients with unstable angina pectoris, 18 patients with
an evolving acute myocardial infarction, and 20 patients with
postinfarction angina. The initial mean percent coronary diameter stenosis
for the entire population was 95 +/- 7% and decreased with initial PTCA to
41 +/- 20% (p less than 0.001), with improved corresponding coronary flow
by Thrombolysis in Myocardial Infarction trial (TIMI) grade. However,
thrombus accumulation then resulted in a significant increase in percent
diameter stenosis to 83 +/- 17% (p less than 0.001); a corresponding
significant reduction in coronary flow also occurred by TIMI grade. After
administration of intracoronary urokinase (mean dose, 141,000 units; range,
100,000-250,000 units during an average period of 34 minutes), with
additional PTCA, mean percent diameter stenosis significantly decreased to
34 +/- 17% (p less than 0.001); a correspondingly significant improvement
in mean coronary flow by TIMI grade occurred to 2.9 +/- 0.2. Overall, the
angiographic success rate was 90%. There were no ischemic events requiring
repeat PTCA and no procedure-related myocardial infarctions or deaths
before hospital discharge. One patient was referred for urgent coronary
artery bypass graft surgery after a successful PTCA. Plasma fibrinogen
levels were obtained in 15 patients, and in no patient was the level below
normal for our laboratory.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Intracoronary urokinase for intracoronary thrombus accumulation complicating percutaneous transluminal coronary angioplasty in acute ischemic syndromes
Department of Medicine, University of California San Diego Medical Center 92103.
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