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Improved prognosis after coronary thrombolysis with urokinase in acute myocardial infarction
R Katori1, K Ishikawa, K Kanamasa
1First Department of Internal Medicine, Kinki University School of Medicine, Osaka, Japan.
Insights
Coronary thrombolysis with urokinase (UK) significantly improves outcomes for acute myocardial infarction patients. This treatment reduced mortality rates and cardiac deaths, offering a better prognosis.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Acute myocardial infarction (MI) remains a leading cause of mortality.
- Effective reperfusion strategies are crucial for improving patient outcomes.
- Urokinase (UK) is a thrombolytic agent with potential for treating MI.
Purpose of the Study:
- To evaluate the effectiveness of coronary thrombolysis with urokinase (UK) on short- and long-term outcomes after acute myocardial infarction (MI).
Main Methods:
- A comparative study involving 120 patients treated with UK and 124 with conventional therapy.
- UK was administered via intracoronary, intravenous, or combined routes within 6 hours of chest pain onset.
- Follow-up was conducted for 20 months to assess mortality and cardiac events.
Main Results:
- Recanalization was achieved in 68.0% of patients treated with UK.
- Cumulative mortality rate was significantly reduced in the UK group (9.2% vs. 29.0%).
- Cardiac death from recurrent MI was also significantly reduced (2.5% vs. 10.5%) in the UK group.
Conclusions:
- Coronary thrombolysis with urokinase therapy significantly improves the prognosis of acute myocardial infarction.
- The benefits of UK therapy were observed across different patient subgroups, including older patients and those with severe MI.
- UK demonstrates effectiveness in reducing mortality and recurrent cardiac events post-MI.
Abstract:
The effectiveness of coronary thrombolysis with urokinase (UK) on short- and long-term outcome after acute myocardial infarction was studied by comparison of 120 patients treated with UK and 124 with conventional therapy followed up for a period of 20 months. UK was administered to patients within 6 hours of the onset of chest pain, by the intracoronary route (20,000 U/min, at a mean dose of 698,000 U) in 46 patients, intravenously (960,000 to 1,920,000 U in 15 or 30 min, at a mean dose of 1,293,000 U) in 56 patients and by the combined route (at a mean dose of 2,333,000 U) in 18 patients. Complete occlusion or 99% stenosis with severe delay of the contrast medium was found in 72.5% and recanalization by UK was achieved in 68.0%. Cumulative mortality rate was significantly reduced in the UK group (9.2% vs. 29.0%). Cardiac death from recurrent MI was also significantly reduced (2.5% vs. 10.5%). The reduction in mortality rate was demonstrated even in older patients as well as in those cases graded as severe according to the Killip and Forrester classifications. Thus, it is concluded that coronary thrombolysis with UK therapy improves the prognosis of acute myocardial infarction.