<Originals>Reduced mortality by coronary thrombolysis with urokinase in acute myocardial infarction

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The efficacy of intracoronary thrombolysis on long-term prognosis of acute myocardial infarction is still controversial, although in-hospital death was significantly decreased. The authors made a comparison in the effectiveness of coronary thrombolysis with urokinase on the short- and the long-term outcome after acute myocardial infarction between 132 patients treated with urokinase and 134 with conventional therapy during a mean follow-up period of 1.5 years. Urokinase was administered to the patients admitted within 6 hours from the onset of chest pain, by an intracoronary route (20,000 U/min, a mean dose of 760,000±370,000 U) in 52 patients, an intravenous one (960,000 to 1,920,000 U in 15 or 30 min, a mean dose of 1,320,000±720,000 U) in 59 patients and a combined one (a mean dose of 2,360,000±600,000 U) in 21 patients. Complete occlusion of the infarct-related coronary arteries or 99% stenosis with severe delay of contrast medium was found in 72.7% of the patients and recanalization of those arteries was achieved in 71.4%. Cumulative mortality rate was significantly (p<0.001) reduced in the urokinase group (9.1%) as compared to the conventional group (31.3%). Recurrent myocardial infarction occurred in 19.7% in the urokinase group and 23.8% in the conventional group, the difference not being significant. However, the rate of death from those recurrent attacks was significantly (p<0.01) lower in the urokinase group than the conventional group (3.0% vs. 9.7%), which may be responsible for the reduced mortality in the long-term prognosis of the urokinase group. The improvement of prognosis was marked in anterior infarction, classes 2 to 4 of the Killip classification, classes 3 and 4 of the Forrester classification and old age group, as compared to non-transmural infarction, class 1 of the Killip, classes 1 and 2 of the Forrester and young age group less than 51 years old, respectively. In conclusion, coronary thrombolysis with urokinase significantly reduced short- and long-term mortality, especially in the patients with severe symptoms and older ages, so that this intervention will be extremely beneficial to acute myocardial infarction.
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<Originals>Reduced mortality by coronary thrombolysis with urokinase in acute myocardial infarction

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