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Safety and efficacy of urokinase during elective coronary angioplasty
G S Pavlides1, T L Schreiber, V Gangadharan
1Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI 48073.
Insights
Adjunctive urokinase during percutaneous transluminal coronary angioplasty (PTCA) appears safe. It may reduce adverse cardiac events in patients with intracoronary thrombus but could increase them in those with intimal dissection.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure for coronary artery disease.
- Adjunctive therapies are used to improve outcomes and reduce complications during PTCA.
- Urokinase, a thrombolytic agent, has been investigated for its role in PTCA.
Purpose of the Study:
- To evaluate the safety and efficacy of adjunctive urokinase during elective PTCA.
- To assess the impact of urokinase on adverse cardiac events in specific patient subgroups.
Main Methods:
- A retrospective analysis of 462 patients undergoing elective PTCA.
- Eighty-nine patients received adjunctive urokinase (group A), compared with 167 controls (group B).
- Patients were stratified by conditions such as unstable angina, intracoronary thrombus, and intimal dissection.
Main Results:
- Procedural success rates were similar between groups.
- Urokinase was associated with a trend towards fewer adverse events in patients with intracoronary thrombus (3% vs 18.5%).
- Urokinase showed a potential increase in adverse events in patients with intimal dissection (20.8% vs 9%).
- Hemorrhagic complications and transfusion rates were comparable between groups.
Conclusions:
- Adjunctive urokinase is safe during elective PTCA.
- Urokinase may be beneficial in reducing adverse events in patients with intracoronary thrombus.
- Urokinase might have an adverse effect in patients with intimal dissection, warranting further investigation.
Abstract:
Eighty-nine of 462 patients were treated with adjunctive urokinase during elective percutaneous transluminal coronary angioplasty (PTCA), 26% for unstable angina, 34% for intracoronary thrombus, 27% for intimal dissection, 10% for abrupt closure, and 3% for saphenous vein graft embolism. The 80 patients treated before abrupt closure (group A) were compared with 167 patients with similar profiles who did not receive urokinase (group B). Procedural success rates were similar. Adverse cardiac events (abrupt closure, myocardial infarction, emergency coronary artery bypass, or death) in group A versus group B occurred in: 1 of 30 (3%) versus 5 of 27 (18.5%) (p = 0.07) with intracoronary thrombus, 5 of 45 (9%) versus 18 of 110 (16.3%) with unstable angina, 1 of 12 (8%) versus 4 of 13 (31%) with unstable angina with intracoronary thrombus, 4 of 33 (12%) versus 14 of 97 (14.4%) with unstable angina without intracoronary thrombus, and 5 of 24 (20.8%) versus 6 of 66 (9%) with intimal dissection. Hemorrhagic complications occurred in 11% of patients who were treated with urokinase versus 9% of patients who were not (p = NS). No difference in blood transfusions existed. Thus urokinase was found to be safe during elective PTCA. In patients with intracoronary thrombus, urokinase appears to decrease the incidence of new adverse cardiac events, whereas in patients with intimal dissection it might have an adverse effect.