급성심근경색증에서 Urokinase 정맥 투여에 대한 임상적 경험

초록

Objectives: The most important therapeutic strategy in acute myocardial infarction(AMI) is early recanalization of infarct-related artery(IRA). In Korea the commonly used method for recanalization is urokinase infusion in early phase of disease. But total dosage and method of urokinase infusion are still arbitary. Thus this study was undertaken to evaluate the patency rate of infarct-related artery by urokinase in AMI patients. Methods: 42 acute myocardial infarction patients were treated with intravenous urokinase(40.000U/kg in 32 patients, 3,00,000U in 10 patients). IRA patency was evaluated with coronary angiography at 90 minutes and 7-10 days after intravenous urokinase. The clinical findings and coronary angiographic findings according to dose of urokinase or pain to time for urokinase injection were analysed prospectively. Results: Mean pain to Door time was 251 minutes and door to urokinase time was 74 minutes. Early patiency of IRA was 61.8%(21/42) and no difference was observed between the dosage of intravenous urokinase. In open IRA group(21 patients) the reocclusion was not observed at 7-10 days later. The ejection fraction on admission was similiar in patent or non-patent IRA group, but follow up ejection fraction was significantly lower in closed IRA group than open IRA group(P=0.0185). Life- threatened bleeding complications were developed in 2 cases(4.8%, I intracranial hemorrhage, 1 gastrointestinal bleeding). Conclusion: IRA patency was achieved in 61.8% of acute myocardial infarction by intravenous urokinase as evaluated by coronary angiography. The patency of IRA at 90 minutes was important in preserving the global left ventricular function in early recovery phase of acute myocardial infarction. But large, prospective study may be needed to determine optimal and effective intravenous urokinase dosage in acute myocardial infarction.