Effects and limitation of CCU--prevention of evolving myocardial infarction.

Emergency coronary angiography and intracoronary thrombolysis were performed on 47 patients who were hospitalized within 12 hours from onset of chest pain. It revealed either a severe stenosis (14 pts: stenosed group) or complete occlusion (33 pts) of infarct-related coronary artery. In 25 out of 33 patients (76%) with complete occlusion, reperfusion was achieved after 10 to 20 minutes of intracoronary urokinase (UK) infusion at a rate of 500IU/kg/min (thrombolysed group). The failure to open coronary artery in remaining 8 patients may have been caused by the occlusion of atheroma itself (unsuccessful group). Left ventricular angiography was performed at one month after attack. In unsuccessful group, the mean age was younger and infarct-nonrelated vessel disease was lower frequency compared to other two groups. Ejection fraction in stenosed, thrombolysed and unsuccessful groups were 56.6 +/- 12, 47.5 +/- 14 and 44.3 +/- 5.1%, respectively. Wall motion assessed by point-score system were 6.7, 5.9 and 3.6, respectively (p less than 0.05 in each group). These facts suggest that early recanalization may result in greater reversal of cardiac function. The time to the peak CPK was shortened in stenosed and thrombolysed groups, but, the values of CPK was maximum in thrombolysed group. Rethrombosis was recognized in 2 patients during 1 to 30 months follow-up. No death and no remarkable complications were seen during this intervention, but 4 late deaths were recognized. Thus, early reperfusion by intracoronary UK infusion is effective therapy to improve cardiac function and reduction of death in AMI.