V. Schachinger et al., ADJUNCTIVE INTRACORONARY UROKINASE THERAPY DURING PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY, The American journal of cardiology, 77(14), 1996, pp. 1174-1178
Uncontrolled studies have suggested that intracoronary urokinase may b
e beneficial in patients undergoing percutaneous transluminal coronary
angioplasty (PTCA). Therefore, 280 consecutive patients undergoing PT
CA were prospectively randomized to receive a bolus injection of 12,50
0 U of heparin followed by a continuous intracoronary infusion via the
guiding catheter of either 250 U heparin per minute or 250 U heparin
plus 5,000 U urokinase per minute during the procedure. Procedural suc
cess rates (<50% final diameter stenosis by quantitative angiography a
nd no major ischemic complications during in-hospital follow-up) were
similar, with 87% in the heparin group (n=135) and 86% in the heparin
plus urokinase group (n=127). Percent diameter stenosis after PTCA was
39 +/- 12% in the heparin group and 41 +/- 12% in the heparin plus ur
okinase group (p=NS). There were no differences between groups with re
spect to PTCA-related acute vessel occlusion, angiographic evidence of
intracoronary thrombus formation, creatine kinase increase after the
procedure, Q-wave myocardial infarction, or emergency coronary artery
bypass surgery. High-risk subgroup analysis revealed no beneficial eff
ect of adjunctive intracoronary urokinase in patients with acute coron
ary insufficiency syndromes (n=86) or in stenoses with an irregular lu
minal contour (n=134). In addition, although risk stratification accor
ding to tile criteria of the American College of Cardiology/American H
eart Association Task Force classification proved to be very useful fo
r the entire study population, no beneficial effect of intracoronary u
rokinase infusion was observed in any of the different risk groups. Th
us, compared with heparin alone, adjunctive intracoronary urokinase th
erapy does not appear to have any beneficial effect upon procedural ou
tcome or on type and frequency of acute complications during PTCA, eve
n in subgroups of patients with a high risk for thrombotic complicatio
ns.