Evaluation of short and long term effects of intracoronary thrombolysis therapy using urokinase in patients with acute myocardial infarction.
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To evaluate the effect of intracoronary thrombolysis (ICT) using urokinase (UK) in acute myocardial infarction, 79 patients were studied. ICT was performed within 6 hours (4.1±1.2 SD) after onset of symptom (Table 1-A and 1-B). Infarction size was estimated by ΣCK (Norris's method) and ECG QRS score (Wagner's method) (Table 2). Cardiac function at the late period (4-7 weeks) was evaluated by left ventricular ejection (LVEF) (Dodge's method). Incidence of total death, re-infarction, post-infarction angina and congestive heart failure (CHF) were observed for the mean period of 18.1±12.8 months.The obstructed coronary artery had been recanalized spontaneously before ICT in 13 patients (group A), was successfully recanalized with ICT in 34 patients (group B) and was not reperfused with ICT in 32 patients (group C). Accordingly successful reperfusion of the obstructed coronary artery with ICT was obtained in 34 out of 66 patients (51.5%) and when recanalization with residual 99% stenosis and delayed filling was inclued in the group of successful reperfusion the rate increased to 63.6%.In 16 patients whose initial QRS score was more than 5, ΣCK and the score at 28-day were highest and LVEF was lowest, regardless of the result that the obstructed coronary artery was recanalized or not (Figure 1, 2 and 3).Among the patients of the first MI with initial QRS score less than 4, ΣCK and 28-day QRS score were lower and LVEF was higher in groups A and B than non-recanalized group C. If the subject was limited to those patients with anterior MI (lesion at #6 or #7) and initial score less than 4, ΣCK and 28-day score were lower and LVEF was higher in groups A and B as compaired to group C, and these difference were statistically significant (p<0.05-0.02) (Figure 1, 2 and 3).Incidence of total death, re-infarction, angina and CHF were 6%, 10%, 32%, and 24% respectively, and the difference among 3 groups was showen in Table 4.In conclusion, ICT seems to be effective on reducing infarction size and preserve cardiac function only in patients with initial QRS score less than 4. The hospital mortality was 5%, post-infarction angina noted in 54% of group A and CHF was most frequently seen in group C.
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