title: [Systemic fibrinolysis in patients with refractory unstable angina].
abstract: We tested the safety and the usefulness of intravenous fibrinolysis in 44 patients with refractory unstable angina, defined as persistence of ischemic episodes during 48-hour Holter monitoring (phase 1) despite maximal medical therapy. After fibrinolysis, recurrence of ischemia was recorded during 1 week of observation in CCU including 2 24-hour Holter monitoring at the beginning and at the end of this week (phase 2): 17 patients completed the observation period without either symptomatic or asymptomatic ischemic episodes (Group A); the remaining 27 patients continued to manifest ischemia (Group B). No bleeding complications occurred. Within a 6-month follow-up, 2 patients of Group A had recurrence of unstable angina while in Group B, 10 patients underwent CABG or PTCA for refractory angina, 6 other patients with refractory angina continued medical therapy, 1 patient had a myocardial infarction and 2 patients died (p less than 0.001). Phase 1: the duration of total ischemia (min/24 hours) was a relevant prognostic marker: higher duration correlated with adverse clinical outcome (p less than 0.01). Phase 2: in comparison with phase 1, duration of total ischemia was significantly reduced (p less than 0.001). A percent value expressing this variation was calculated for each patient: (min of ischemia in phase 2 - min of ischemia in phase 1/min of ischemia in phase 1). The variation thus obtained again gave information on the clinical outcome: the greater was the reduction, the lower was the risk of cardiac events (p less than 0.001). Our data suggest that: clinical stabilization may be obtained with the addition of fibrinolysis to conventional treatment; Holter monitoring bears prognostic information helpful in identifying patients who need further intervention.
authors.affiliation: Cattedra di Malattie dell'Apparato Cardiovascolare, Università degli Studi, Genova.
authors.forename: C
authors.initials: C
authors.lastname: Brunelli
authors.forename: P
authors.initials: P
authors.lastname: Spallarossa
authors.forename: G
authors.initials: G
authors.lastname: Ghigliotti
authors.forename: M
authors.initials: M
authors.lastname: Caudullo
authors.forename: L
authors.initials: L
authors.lastname: Pastorino
authors.forename: P B
authors.initials: PB
authors.lastname: Lantieri
authors.forename: M
authors.initials: M
authors.lastname: Iannetti
authors.forename: S
authors.initials: S
authors.lastname: Caponnetto
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis / Q000188:drug therapy*; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D015912:Thrombolytic Therapy; D013997:Time Factors; D014568:Urokinase-Type Plasminogen Activator / Q000009:adverse effects
chemical_list: D014568:Urokinase-Type Plasminogen Activator
vernacular_title: Fibrinolisi sistemica in pazienti con angina instabile refrattaria.