ANGIOGRAPHIC STUDY OF MUTANT TISSUE-TYPE PLASMINOGEN-ACTIVATOR VERSUSUROKINASE FOR ACUTE MYOCARDIAL-INFARCTION

The effects and problems of intravenous thrombolytic therapy with a bo lus injection of mutant tissue plasminogen activator (t-PA) were inves tigated in 34 patients with first acute myocardial infarction (AMI). I n contrast, 114 patients were selected from 1,003 patients with AMI fo r treatment using intravenous infusion urokinase (UK). Angiography of these 148 patients revealed a complete occlusion of infarct-related ar tery with no clear contraindications to the study treatment. With the exception of thrombolysis in myocardial infarction (TIMI-3) recanaliza tion 60 min after a bolus injection of mutant t-PA, the patients were given intracoronary UK in addition to mutant t-PA. The study compariso ns were assessed using the following criteria: (1) 60-min assessment o f recanalization rates, mutant t-PA vs UK; (2) time interval from init iation of thrombolysis to recanalization, mutant t-PA vs UK; (3) angio graphic reocclusion rates within 1 month, mutant t-PA alone vs UK vs m utant t-PA plus UK; and (4) intracerebral hemorrhage rates, mutant t-P A alone vs UK vs mutant t-PA plus UK. There were no significant differ ences in the recanalization rates between mutant t-PA and UK, but ther e was a significant reduction in the time to recanalization with mutan t t-PA (31.8+/-12.7 min) compared with UK (56.5+/-6.3 min). There was a significant difference in the reocclusion rates among the 3 treatmen t groups (20% mutant t-PA alone vs 4% UK vs 0% mutant t-PA plus UK). O n the other hand, no significant differences in intracerebral hemorrha ge rates among the 3 treatments were observed. In conclusion, thrombol ytic therapy with a bolus injection of mutant t-PA achieved more rapid recanalization, but treatment with mutant t-PA led to a high rate of reocclusion.