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Unstable angina and thrombolysis.

J D Rutherford1

  • 1Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston 02115.

Chest
|April 1, 1990
PubMed
Summary

Unstable angina patients with coronary thrombus may benefit from thrombolytic therapy. Large trials are investigating if tissue plasminogen activator (rt-PA) improves outcomes compared to conventional treatments.

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Area of Science:

  • Cardiology
  • Thrombosis
  • Interventional Cardiology

Background:

  • Unstable angina (UA) affects diverse patient groups.
  • Coronary artery thrombus is frequently observed in patients with rest angina and predicts adverse events like myocardial infarction and death.
  • Small studies suggest thrombolytic therapy may resolve thrombus and improve outcomes in UA.

Purpose of the Study:

  • To evaluate the efficacy of thrombolytic therapy, specifically recombinant tissue plasminogen activator (rt-PA), in patients with unstable angina and non-Q-wave infarction.
  • To determine if rt-PA improves angiographically assessed coronary stenoses.
  • To compare rt-PA with conventional therapy and assess the need for routine angiography and revascularization.

Main Methods:

  • Large-scale, multicenter clinical trials were designed.
  • Patients with unstable angina and non-Q-wave infarction were enrolled.
  • Investigated the impact of rt-PA on coronary stenoses, clinical outcomes, and the necessity of subsequent interventions.

Main Results:

  • Ongoing large multicenter trials aim to answer key questions regarding rt-PA efficacy.
  • Results are pending to confirm if rt-PA improves coronary stenoses and clinical outcomes.
  • The optimal role of rt-PA in unstable angina management requires further investigation.

Conclusions:

  • The role of thrombolytic therapy, including rt-PA, in unstable angina remains speculative pending results from large clinical trials.
  • Further research is needed to establish the benefits and optimal use of rt-PA in this patient population.
  • The study highlights the need for evidence-based guidelines for thrombolytic therapy in unstable angina.

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