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[Conservative therapeutic approaches in terminal coronary heart disease. Chronic intermittent urokinase therapy]
M Leschke1, F C Schoebel, T W Jax
1Klinik für Kardiologie, Pneumologie und Angiologie, Heinrich-Heine-Universität Düsseldorf.
Insights
Long-term intermittent urokinase therapy improves cardiac function and quality of life in patients with refractory angina. This antithrombotic intervention enhances blood flow and may lead to plaque regression in end-stage coronary artery disease.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Symptomatic coronary artery disease (CAD) affects many patients, with some developing end-stage disease and refractory angina pectoris.
- Conventional treatments improve quality of life but do not fully address severe coronary insufficiency.
- Refractory angina is characterized by a mismatch between severe coronary stenosis and viable myocardium.
Purpose:
- To evaluate the efficacy of long-term intermittent urokinase therapy as an antithrombotic intervention for refractory angina pectoris.
- To assess the impact of urokinase therapy on thrombolysis, blood rheology, and potential plaque regression.
- To investigate improvements in myocardial perfusion, left ventricular function, and quality of life in patients with refractory angina.
Summary:
- Long-term intermittent urokinase therapy was investigated for refractory angina pectoris.
- The therapy enhances thrombolysis and blood rheology, potentially leading to plaque regression.
- Supportive measures, including LDL-cholesterol reduction, are crucial before initiating urokinase therapy.
Impact:
- Urokinase therapy demonstrated significant improvements in objective signs of ischemic heart failure.
- Left ventricular ejection fraction increased, and diastolic function normalized after 12 weeks of treatment.
- Clinical benefits persisted beyond the treatment period, with a remarkable increase in patients' quality of life.
Abstract:
Despite progress in the invasive revascularization procedures and even though conventional antianginal treatment has improved the quality of life in patients with symptomatic coronary artery disease considerably, an increasing number of patients suffers from end-stage coronary artery disease and refractory angina pectoris. For these refractory patients long-term intermittent urokinase therapy was developed as an antithrombotic intervention, which is based on its capacity to enhance thrombolysis and blood rheology, and may possibly lead to plaque regression. The coronary syndrome of refractory angina pectoris is characterized by a mismatch of severe coronary insufficiency and a relatively large amount of viable myocardium as indicated by an only moderately impaired left ventricular function. Prior to initiation of long-term intermittent urokinase therapy all potential measures to improve myocardial perfusion have to be considered in each patient. These supportive measures include rigorous reduction of LDL-cholesterol, which has proven antiischemic properties due to an improved endothelial function of epicardial conductance vessels possibly resulting in an antianginal effect. Apart from the proven antiischemic properties of long-term intermittent urokinase therapy in patients with refractory angina pectoris, objective signs of ischemic myocardial heart failure improve. Follow-up studies demonstrated a significant increase of left ventricular ejection fraction as evaluated with multi-gated blood pool analysis. Furthermore, left ventricular diastolic function normalized after a treatment period of 12 weeks. As the clinical effects last well beyond the actual treatment period and as they are accompanied by a remarkable increase in the quality of life, a complex approach as this one is justified in this highly symptomatic patient group.