Adjunctive thrombolytic therapy for angioplasty in ischemic rest angina: Results of a double-blind randomized pilot study

Ambrose, John A.; Torre, Sabino R.; Sharma, Sanjeev; Israel, Douglas H.; Monsen, Craig E.; Weiss, Melvin B.; Untereker, William J.; Grunwald, Andrew M.; J, Moses; Marshall, James; Bunnell, Do Paul; Sobolski, John

doi:10.1016/0735-1097(92)90378-z

Cited by 25 publications

(11 citation statements)

References 21 publications

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“…In this situation, the administration of intracoronary thrombolytic agents along with redilatation has been reported to improve angiographic and clinical success.5-8 We previ-ously published the results of a small randomized, double-blind pilot study assessing the role of small doses of intracoronary urokinase as prophylaxis immediately before angioplasty for ischemic rest angina. 9 This study suggested that the formation of intracoronary thrombus after angioplasty could be decreased by intracoronary urokinase, although acute closure and in-hospital clinical events were similar to those in patients treated with placebo. To further assess the role of thrombolytic therapy in this circumstance, a larger trial was undertaken with higher doses of urokinase and monitoring of heparin therapy with activated coagulation times.…”

mentioning

confidence: 92%

Adjunctive thrombolytic therapy during angioplasty for ischemic rest angina. Results of the TAUSA Trial. TAUSA Investigators. Thrombolysis and Angioplasty in Unstable Angina trial.

et al. 1994

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for the TAUSA Investigators Background Acute closure is increased after angioplasty in unstable angina, and adjunctive intracoronary thrombolytic therapy has been used successfully to increase angiographic success. The role of prophylactic thrombolytic therapy during angioplasty in unstable angina is unknown.Methods and Results Four hundred sixty-nine patients with ischemic rest pain with or without a recent (<1 month) infarction were randomized in double-blind fashion to intracoronary urokinase or placebo. Randomization was carried out in two sequential phases. In phase I, 257 patients were randomized to 250 000 U of urokinase or placebo given in divided doses at the time of angioplasty. In phase II, 212 patients were randomized to 500 000 U of urokinase or

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confidence: 92%

Adjunctive thrombolytic therapy during angioplasty for ischemic rest angina. Results of the TAUSA Trial. TAUSA Investigators. Thrombolysis and Angioplasty in Unstable Angina trial.

et al. 1994

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“…Angiographic resolution of intracoronary thrombus has been variable after intracoronary thrombolysis before angioplasty, but the results have largely been discouraging [5][6][7][8] . As a result, intracoronary thrombolysis is rarely used in clinical practice; however, several studies still support the usefulness of intracoronary thrombolysis in selected cases.…”

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confidence: 99%

Successful Revascularization of Coronary Artery Occluded by Massive Intracoronary Thrombi with Alteplase and Percutaneous Coronary Intervention

Kim

Jang

et al. 2010

JAT

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A 67-year-old man was admitted to our institution with sudden and pessistant chest pain for 3 days. Coronary angiography showed massive thrombotic occlusion of the right coronary artery. The patient received intracoronary thrombolysis with alteplase (recombinant tissue-type plasminogen activator, rt-PA). On repeated angiography, there was marked resolution of intracoronary thrombus. After percutaneous coronary intervention with stent implantation, the final result was complete revascularization of the right coronary artery (TIMI grade 3 distal flow). This case demonstrates that intracoronary rt-PA can result in local thrombus reduction in patients undergoing PCI, especially with a large thrombus burden.

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“…[11][12][13][14][15][16] It also provided the definition used in the Unstable Angina Guidelines. 17 Since the introduction of this classification, considerable progress has been made in understanding the pathophysiology of unstable angina and treatment of this condition.…”

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A Classification of Unstable Angina Revisited

2000

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Abstract-Unstable angina is a critical phase of coronary heart disease with widely variable symptoms and prognosis. A decade ago, a classification of unstable angina based on clinical symptoms was introduced. This system was then validated by prospective clinical studies to correlate with the prognosis and was linked to angiographic and histological findings. It has been used to categorize patients in many large clinical trials. In recent years, the pathophysiological roles of platelet activation and inflammation in unstable angina have been elucidated. Subsequently, improved markers of myocardial injury, acute-phase proteins, and hemostatic markers that may be associated with clinical outcomes have been identified. Particularly, cardiac-specific troponin T and troponin I have been shown to represent the best predictors of early risk in patients with angina at rest. Accordingly, it is suggested that the original classification be extended by subclassifying one large group of unstable angina patients, ie, those with angina at rest within the past 48 hours (class IIIB), into troponin-positive (T pos ) and troponin-negative (T neg ) patients. The 30-days risk for death and myocardial infarction is considered to be up to 20% in class IIIB-T pos but Ͻ2% in class IIIB-T neg patients. Initial results suggest that troponins may function as surrogate markers for thrombus formation and can effectively guide therapy with glycoprotein IIb/IIIa antagonists or low-molecular-weight heparins. These observations provide additional impetus for adding the measurement of these markers to the clinical classification and represent a novel concept of treating these high-risk patients. (Circulation. 2000;102:118-122.)Key words: angina Ⅲ atherosclerosis Ⅲ coronary disease Ⅲ myocardial infarction Ⅲ prognosis I t has long been recognized that coronary artery disease comprises a wide spectrum of conditions, ranging from chronic stable angina to acute myocardial infarction. Unstable angina, in the middle of this spectrum is a heterogeneous syndrome with widely variable symptoms and prognosis. In 1989, a classification of unstable angina was introduced 1 ; this classification is based on the clinical history (accelerated exertional angina or rest pain, the timing of the latter in respect to presentation, and the clinical circumstances in which unstable angina developed), on the presence or absence of ECG changes, and on the intensity of anti-ischemic therapy.Although the development of this classification was based on clinical experience, it has been validated in a number of prospective studies. For example, Calvin et al 2 studied 393 patients with unstable angina and reported that a history of a myocardial infarction within 14 days (class C) and STsegment depression on the presenting ECG were both markers of increased risk. Miltenburg-van Zijl et al 3 classified 417 patients with unstable angina and followed them up for 6 months. Death or myocardial infarction occurred more frequently in those with recent rest pain (class III) and in postin...

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Adjunctive thrombolytic therapy for angioplasty in ischemic rest angina: Results of a double-blind randomized pilot study

Cited by 25 publications

References 21 publications

Adjunctive thrombolytic therapy during angioplasty for ischemic rest angina. Results of the TAUSA Trial. TAUSA Investigators. Thrombolysis and Angioplasty in Unstable Angina trial.

Adjunctive thrombolytic therapy during angioplasty for ischemic rest angina. Results of the TAUSA Trial. TAUSA Investigators. Thrombolysis and Angioplasty in Unstable Angina trial.

Successful Revascularization of Coronary Artery Occluded by Massive Intracoronary Thrombi with Alteplase and Percutaneous Coronary Intervention

A Classification of Unstable Angina Revisited

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