title: Clinical experience with intracoronary tissue plasminogen activator: results of a multicenter registry. Intracoronary t-PA Registry Investigators.
abstract: Clinical experience with the use of intracoronary tissue plasminogen activator (t-PA) is limited. We therefore undertook this study to document current clinical usage of intracoronary t-PA during a 2-yr period in a multicenter registry. Intracoronary t-PA was utilized on 206 occasions in 198 patients (154 men and 44 women; mean age, 59 +/- 12 yr). The mean dose of intracoronary t-PA was 31 +/- 15 mg. Indications for use included acute myocardial infarction (MI) (n = 83), preexisting thrombus with (n = 49) or without (n = 41) percutaneous transluminal coronary angioplasty (PTCA), unstable angina (n = 14), abrupt vessel closure (n = 11), and post-PTCA "clean-up" (n = 8). The Thrombolysis in Myocardial Infarction (TIMI Phase I) criteria were used to assess perfusion and degree of thrombus formation. Overall, the mean TIMI flow grade increased from 1.2 +/- 1.1 before treatment to 2.3 +/- 1.0 after treatment (P < 0.0001); the mean TIMI thrombus grade decreased from 3.2 +/- 1.0 before treatment to 1.6 +/- 1.4 after treatment (P < 0.0001). Complications included bleeding (9.2%), MI (17.6%), need for coronary artery bypass grafting (CABG) (9.2%), need for repeat PTCA/atherectomy/stents (4.9%), and ventricular fibrillation (1.7%, all associated with opening totally occluded vessels). There were 14 subsequent in-hospital deaths: 13 of the patients who died had originally presented with MI; the other had experienced abrupt vessel closure during a PTCA procedure. Intracoronary t-PA appears to be effective in improving distal flow and decreasing thrombus burden; however, intracoronary delivery of t-PA has associated risks.(ABSTRACT TRUNCATED AT 250 WORDS)
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003326:Coronary Circulation / Q000187:drug effects; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011859:Radiography; D012008:Recurrence; D012042:Registries; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator