Coronary thrombolysis with urokinase infusion in acute myocardial infarction: Multicenter study in Japan

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.

Comparison of the Efficacy of Reperfusion Therapies for Early Mortality From Acute Myocardial Infarction in Japan

“…1-2,4,7,13-27 Moreover, the mortality of patients who did not undergo any reperfusion therapies was also identical to that of the previous reports. 8,25,[28][29][30][31] It is unlikely that the patients could not undergo reperfusion because they were in an extremely severe condition. The crude mortality in patients aged less than 75 years was shown (Fig 4) to be comparable with some RCT in which patients older than 75 were excluded.…”

Thrombolysis of Canine Femoral Artery Thrombus by a Novel Modified Tissue-Type Plasminogen Activator (E6010).

“…In 1979, Rentrop et al succeeded in lysing a coronary thrombus by direct intracoronal infusion of streptokinase (2). In Japan, percutaneous transluminal coronary recanaliza tion (PTCR) with urokinase has been commonly per formed (3). These drugs can lyse fibrin that is a compo nent of thrombi by converting plasminogen into the ac tive form, plasmin, in the circulating blood.…”

Can Thrombolysis Prevent Ischemic Heart Failure?

“…Most importantly, early recanalization, whether by guidewire alone [19] or by clot lysis with urokinase [27] or recombinant tis sue plasminogen activator [28][29][30], with or without PTCA [31] have all been shown to limit infarct size [7,8,32], preserve cardiac function [7,8,33] and reduce early as well as late mortality [7,8,14,15]. Thus the earlier requirements to demonstrate efficacy have largely been met and it is now more a matter of implementation of this strategy than of finding the optimal agent or technique.…”