Acute myocardial infarctions in the vast majority of cases are caused by coronary artery thrombosis at the site of complicated arteriosclerotic plaques. By several trials evidence has been given, that myocard can be preserved, when thrombolytic therapy is started within a short period after thrombotic coronary occlusion. Recently, angioscopic evidence has been given, that the unstable angina pectoris syndrome frequently is assciated with coronary artery thrombosis, too. Thus, thrombolytic therapy should be of comparable benefit for patients suffering from unstable angina pectoris syndrome. Up to now, we have treated four patients suffering from unstable angina pectoris syndrome (two with documented spontaneous reversible ST-segment elevations, two with newly complained recurrent nocturnal episodes of severe angina) with thrombolytic therapy (Pat. 1: 1.5 Mio IE Streptokinase; Pat. 2: 100 mg rt-PA; Pat. 3: 150 mg rt-PA; Pat. 4: 60 mg scu-PA plus 200 000 IE UK). After thrombolytic therapy, all four patients were free of symptoms for at least 60 h. Pat. 3 had recurrance of chest pain with spontaneous reversible ST-segment elevations on the third day after therapy. Pat. 1, 2, and 4 were without clinical symptoms until angiography and secondary intervention (angioplasty (PTCA) /bypass operation (CABG)). Cardiac catheterization was performed within one week after thrombolytic therapy. In all four patients, ischemia related coronary artery was patent at angiography. We conclude, that in unstable angina pectoris syndromes with newly developed nocturnal symptoms and/or spontaneous reversible ST-segment elevations in the ECG can be stabilized by thrombolytic therapy. After thrombolysis, however, recurrance of chest pain may be soon, and PTCA or CABG should be performed as soon as possible.
Thrombolytic therapy for unstable angina pectoris: Rationale and results
