Results of high dose intravenous urokinase for acute myocardial infarction

Thomas C. Wall, Harry R. Phillips, Richard S. Stack, Susan Mantell, Lynne Aronson, Jane Boswick, Kristina Sigmon, Michael DiMeo, Don Chaplin, David Whitcomb, Depak Pasi, Mark Zawodniak, Moosa Hajisheik, Sadanaud Hegde, Walter Barker, Richard Tenney, Robert M. Califf

Research output: Contribution to journalArticle

37 Scopus citations

Abstract

To determine the outcome of patients after treatment with high-dose intravenous urokinase (3 million U) 102 patients were prospectively evaluated in the setting of acute myocardial infarction. The first 61 patients received intravenous urokinase as a continuous infusion and the last 41 patients were treated with an initial 1.5 million U intravenous bolus. Sixty-two percent of all patients had patent infarct-related arteries by the time of immediate angiography (median time 2.2 hours), which was performed in all patients. There was no significant difference in patency rates between patients treated with or without an initial intravenous bolus. Twenty-eight (28%) patients developed clinical evidence of recurrent ischemia (death, reocclusion, emergency angioplasty, urgent bypass surgery) during hospitalization, whereas only 7 (7%) developed angiographically documented reocclusion. Of 28 patients who failed to achieve successful reperfusion at the time of immediate catheterization, rescue angioplasty was technically successful in establishing reperfusion in all but 1 patient. No significant improvement in median global left ventricular function was seen between immediate (48%) and follow-up catheterization (48%). Significant bleednig complications were unusual except in 1 patient who experienced an intracranial hemorrhage. Eight (8%) patients died during hospitalization. Therefore, the use of high-dose intravenous urokinase in patients with acute myocardial infarction is associated with a 62% patency rate, a low incidence of reocclusion and bleeding complications and a high technical success rate with rescue angioplasty at the time of immediate catheterization. This study supports the need for further randomized controlled trials comparing intravenous urokinase directly with other thrombolytic regimens.

Original languageEnglish (US)
Pages (from-to)124-131
Number of pages8
JournalThe American Journal of Cardiology
Volume65
Issue number3
DOIs
StatePublished - Jan 15 1990
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Wall, T. C., Phillips, H. R., Stack, R. S., Mantell, S., Aronson, L., Boswick, J., Sigmon, K., DiMeo, M., Chaplin, D., Whitcomb, D., Pasi, D., Zawodniak, M., Hajisheik, M., Hegde, S., Barker, W., Tenney, R., & Califf, R. M. (1990). Results of high dose intravenous urokinase for acute myocardial infarction. The American Journal of Cardiology, 65(3), 124-131. https://doi.org/10.1016/0002-9149(90)90072-9