INTRACORONARY UROKINASE FOR INTRACORONARY THROMBUS ACCUMULATION COMPLICATING PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY IN ACUTE ISCHEMIC SYNDROMES

Intracoronary urokinase was used to treat flow-limiting intracoronary thrombus accumulation that complicated successful percutaneous transluminal coronary angioplasty (PTCA) during acute ischemic syndromes in 48 patients who were followed up through the acute phase of their illness. The study group comprised 10 patients with unstable angina pectoris, 18 patients with an evolving acute myocardial infarction, and 20 patients with postinfarction angina. The initial mean percent coronary diameter stenosis for the entire population was 95 ± 7% and decreased with initial PTCA to 41 ± 20% (p < 0.001), with improved corresponding coronary flow by Thrombolysis in Myocardial Infarction trial (TIMI) grade. However, thrombus accumulation then resulted in a significant increase in percent diameter stenosis to 83 ± 17% (p < 0.001); a corresponding significant reduction in coronary flow also occurred by TIMI grade. After administration of intracoronary urokinase (mean dose, 141,000 units; range, 100,000-250,000 units during an average period of 34 minutes), with additional PTCA, mean percent diameter stenosis significantly decreased to 34 ± 17% (p < 0.001); a correspondingly significant improvement in mean coronary flow by TIMI grade occurred to 2.9 ± 0.2. Overall, the angiographic success rate was 90%. There were no ischemic events requiring repeat PTCA and no procedure-related myocardial infarctions or deaths before hospital discharge. One patient was referred for urgent coronary artery bypass graft surgery after a successful PTCA. Plasma fibrinogen levels were obtained in 15 patients, and in no patient was the level below normal for our laboratory. Angiographic follow-up was obtained in 79% of patients (average time 30 days with 63% of all patients studied before discharge), and in no patient was there angiographic evidence of reocclusion, although two patients showed angiographic evidence of stenosis; improved vessel percent stenosis persisted, averaging 32 ± 17%. In all patients studied, the coronary flow was TIMI grade 3 at follow-up. Thus, in patients with acute ischemic syndromes with flow-limiting intracoronary thrombus accumulation that complicated PTCA, intracoronary urokinase with repeated PTCA proved to be highly effective in restoring vessel patency and avoiding early complications.