急性心筋硬塞に対する冠動脈内血栓融解療法

Abstract

We studied 15 patients (age 27-72 years old) with acute myocardial infarction who were admitted to Kansai Medical University within 14 hours (Mean 5.3 hours) after the onset of chest pain.Total obstruction was seen in 11 patients and spontaneous recanalization in 4 patients at the time of acute coronary angiography.Percutaneous transluminal coronary recanalization was performed in all patients. A bolus of isosorbide dinitrate (5 mg) was infused into the ischemia-related coronary artery. Five minutes later, a bolus of urokinase (120000 unit) was infused into the same coronary artery and coronary angiography was performed.When recanalization of th e coronary artery was not found, urokinase was administered at a rate of 250-400 u/kg/hour to the maximum dose of845000 units. Among 11 patients with total obstruction, recanalization oc curred in one patient with isosorbide dinitrate and in 10 patients, recanalization occurred with urokinase.Chest pain alleviated after reperfusion in all patients. In 4 patients whom spontaneous reanalization was found at acute coronary angiography, intracoronary urokinase infustion did not result in the improvement of the stenosis. Angiography was repeated 30-40 days after the acute study in 11 patients. Improvement of coronary artery stenosis was found in 6 patients.Although aleviation of chest pain was seen with percutaneous transluminal coronary recanalization, further study will be needed to evaluated the efficacy of this method in improving cardiac function.