Adjunctive intracoronary urokinase therapy during percutaneous transluminal coronary angioplasty

Uncontrolled studies have suggested that intracoronary urokinase may be beneficial in patients undergoing percutaneous transluminal coronary angioplasty (PTCA). Therefore, 280 consecutive patients undergoing PTCA were prospectively randomized to receive a bolus injection of 12,500 U of heparin followed by a continuous intracoronary infusion via the guiding catheter of either 250 U heparin per minute or 250 U heparin plus 5,000 U urokinase per minute during the procedure. Procedural success rates (<50% final diameter stenosis by quantitative angiography and no major ischemic complications during in-hospital follow-up) were similar, with 87% in the heparin group (n = 135) and 86% in the heparin plus urokinase group (n = 127). Percent diameter stenosis after PTCA was 39 ± 12% in the heparin group and 41 ± 12% in the heparin plus urokinase group (p = NS). There were no differences between groups with respect to PTCA-related acute vessel occlusion, angiographic evidence of intracoronary thrombus formation, creatine kinase increase after the procedure, Q-wave myocardial infarction, or emergency coronary artery bypass surgery. High-risk subgroup analysis revealed no beneficial effect of adjunctive intracoronary urokinase in patients with acute coronary insufficiency syndromes (n = 86) or in stenoses with an irregular luminal contour (n = 134). In addition, although risk stratification according to the criteria of the American College of Cardiology/American Heart Association Task Force classification proved to be very useful for the entire study population, no beneficial effect of intracoronary urokinase infusion was observed in any of the different risk groups. Thus, compared with heparin alone, adjunctive intracoronary urokinase therapy does not appear to have any beneficial effect upon procedural outcome or on type and frequency of acute complications during PTCA, even in subgroups of patients with a high risk for thrombotic complications.