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Chronic-intermittent urokinase therapy in patients with end-stage coronary artery disease and refractory angina
F C Schoebel1, M Leschke, T W Jax
1Clinic for Cardiology, Pneumology, and Angiology, Heinrich Heine University Düsseldorf, Germany.
Insights
Chronic-intermittent urokinase therapy significantly reduced angina symptoms and improved blood flow in patients with severe coronary artery disease. This treatment offers an effective alternative for refractory angina when invasive procedures are not an option.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Coronary artery disease (CAD) with severe angina pectoris poses a clinical challenge for patients unresponsive to standard treatments.
- Limited invasive revascularization options necessitate alternative therapeutic strategies for refractory angina.
Purpose of the Study:
- To evaluate the efficacy and safety of chronic-intermittent urokinase therapy in patients with end-stage CAD and refractory angina.
- To assess the impact of urokinase therapy on anginal symptoms, rheological parameters, and exercise tolerance.
Main Methods:
- Twenty patients with refractory angina received intravenous urokinase (500,000 IU) three times weekly for 12 weeks.
- Measurements included anginal symptom frequency, fibrinogen levels, plasma viscosity, red blood cell aggregation, exercise tolerance, and ST-segment depression.
Main Results:
- A significant 74% average reduction in weekly anginal events was observed.
- Fibrinogen levels decreased by 34%, plasma viscosity by 6.1%, and red blood cell aggregation by 18%.
- Exercise tolerance increased by 51%, and ST-segment depression decreased, with sustained benefits at 12-week follow-up.
Conclusions:
- Chronic-intermittent urokinase therapy is an effective anti-ischemic and antianginal treatment for patients with refractory angina and end-stage CAD.
- Therapeutic mechanisms likely involve improved rheological blood properties and thrombolytic effects.
- This approach provides a viable option for patients ineligible for invasive revascularization.
Abstract:
Patients with coronary artery disease and severe angina pectoris refractory to conventional medical treatment (beta blockers, nitrates, calcium antagonists) and without the option for invasive revascularization procedures represent an increasing clinical problem. For these patients, chronic-intermittent urokinase therapy has been developed. Twenty patients received 500,000 IU urokinase as intravenous bolus injection 3 times a week over a period of 12 weeks. The average reduction in anginal symptoms in 19 patients was 74%, from 23.5 +/- 10.8 to 5.2 +/- 4.8 events/week (p < 0.001); 1 patient was excluded from further treatment because of an increase of > 66% in anginal events. Fibrinogen decreased by 34% from 370 +/- 57 to 244 +/- 44 mg/dl (p < 0.001), the rheological parameters plasma viscosity by 6.1% from 1.39 +/- 0.04 to 1.31 +/- 0.03 mPas (< 0.001), and red blood cell aggregation by 18% from 13.9 +/- 2.4 to 11.2 +/- 2.2 (p < 0.001). Exercise tolerance increased by 51%. Average ST-segment depression decreased from 0.16 +/- 0.10 to 0.12 +/- 0.09 (p < 0.01). After 12 weeks of follow-up, angina pectoris and fibrinogen levels were still significantly reduced compared with baseline values. Chronic-intermittent urokinase therapy represents an effective anti-ischemic and antianginal approach in patients with refractory angina pectoris and end-stage coronary artery disease. Improvement of rheological blood properties and thrombolytic effects are likely therapeutic mechanisms.