老年者急性心筋梗塞における経静脈的冠動脈内血栓溶解療法の臨床的検討

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  • 坂井 誠
    東京都老人医療センター循環器科
  • 松下 哲
    東京都老人医療センター循環器科 東京都多摩老人医療センター循環器科
  • 上田 慶二
    東京都老人医療センター循環器科
  • 蔵本 築
    東京都老人医療センター循環器科

書誌事項

タイトル別名
  • Intravenous short-term coronary thrombolysis by a high-dose urokinase in aged patients with acute myocardial infarction.
  • ロウネンシャ キュウセイ シンキン コウソク ニ オケル ケイ ジョウミャクテ

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In order to investigate whether a high-dose, rapid intravenous infusion of urokinase (UK) is a safe and efficient therapy in aged patient with acute myocardial infarction (AMI), electrocardograms, serum enzyme activities, hemodynamics, 201-Tl myocardila scintigrams and radionuculide angiocardiograms were studied in two groups of patients over 60 yeras of age who were admitted within 6 hours of the onset of symptoms of AMI. Eighteen patients received conventional therapy (C group) and 15 patients received a high-dose rapid infusion of UK (960, 000 IU) intravenously (UK group). The numbers of male patients and patients with anterior wall infarction were slightly greater in the C group than in the UK group. Mean age, time from the onset of symptoms to admission, and distribution of Killip's classification on admission did not differ between the two groups. Bleeding complications were not observed in the UK group. The mortality rate after 7 days from the onset of AMI tended to be lower in the UK group (13%) than in the C group (44%). Sum of ST elevation and QRS score on admission, peak CPK and CPK-MB levels, time to peak levels, hemodynamics (cardiac index, pulmonary capillary wedge pressure and stroke work index) on admission and on the 5th or 6th day after admission, and left ventricular ejection fraction in the convalescent phase did not differ between the two groups. The decreasing rate of sum of ST elevation on the 2nd day after admission was significantly greater in the UK grop than in the C group (-68.1±5.6% vs -41.6±7.4%, p<0.05) and sum of ST elevation decreased serially until the 7th day after admission in the UK group. QRS scores on the 5th day after admission were significantly lower in the UK group than in the C group (2.0±0.7 vs 4.6±0.8 p<0.025). Defect scores assessed qualitatively from 201-Tl myocardial scintigrams were significantly lower in the UK group than in the C group (7.7±1.6 vs 12.9±1.1 p<0.025). Thus, thrombolysis with a high-dose rapid infusion of UK was safe and effective in limiting myocardial injury in aged patients with acute myocardial infarction.

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