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Coronary thrombolysis with urokinase infusion in acute myocardial infarction: multicenter study in Japan
Insights
Intracoronary urokinase effectively achieved coronary thrombolysis in 66.8% of acute myocardial infarction patients. Sufficient dosage improved outcomes and reduced in-hospital mortality, with manageable complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Acute myocardial infarction (AMI) remains a leading cause of mortality.
- Timely restoration of coronary blood flow is critical for patient outcomes.
- Limited efficacy of initial treatments necessitates exploring advanced therapeutic options.
Purpose of the Study:
- To evaluate the efficacy and safety of intracoronary urokinase for treating acute myocardial infarction.
- To determine optimal dosing and infusion parameters for successful coronary thrombolysis.
- To assess the impact of successful thrombolysis on in-hospital mortality.
Main Methods:
- A cohort of 514 patients with AMI received intracoronary urokinase.
- Coronary arteriography was performed to assess baseline and post-treatment status.
- Recanalization rates, complication profiles, and mortality were analyzed based on urokinase dosage and infusion speed.
Main Results:
- Successful coronary thrombolysis was achieved in 66.8% of patients.
- Lower success rates were observed with infusion speeds >30,000 units/min or total doses ≤480,000 units.
- Complications, primarily arrhythmias, occurred in 33.2% of successful cases; serious hemorrhage was rare.
- Successful thrombolysis was associated with significantly lower in-hospital mortality (6.3% vs 13.3%).
Conclusions:
- Intracoronary urokinase administration is an effective treatment for acute myocardial infarction.
- Adequate dosing and infusion rates are crucial for successful thrombolysis.
- The procedure offers a relatively safe therapeutic option with a significant reduction in mortality.
Abstract:
The efficacy of intracoronary administration of urokinase was evaluated in 514 patients with acute myocardial infarction (anterior, 296 patients; inferior, 195; lateral or posterior, 18; and anterior and inferior, five). The time between onset of chest pain and coronary arteriography was 0.5 to 81.0 hr with an average of 5.0 hr. Initial administration of nitrates resulted in recanalization of the coronaries in 9.3%. Subsequently, urokinase was infused into the coronary arteries, and coronary thrombolysis was successfully achieved in 66.8%. The success rate was low in a group with average infusion speed of more than 30,000 units/min or with a total dose of urokinase of 480,000 units or less. Complications, mainly arrhythmias, were present in 111 patients (33.2%) of the 334 who had successful thrombolysis and in 18 patients (10.8%) of the 166 with unsuccessful thrombolysis, but serious hemorrhage was rare and no fatal case was reported. Patients who had successful thrombolysis had less in-hospital mortality than those who did not (6.3 vs 13.3%). Thus, coronary thrombolysis can be achieved effectively and relatively safely with a sufficient amount of intracoronary urokinase administration in acute myocardial infarction.