Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: EC:3.4.21.73 (urokinase-type plasminogen activator)
 10,685 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical efficacy of intravenous fibrinolytic treatment using a moderate dose of urokinase (UK) on acute myocardial infarction (AMI) has not been well evaluated in randomized trials. In order to assess the efficacy of UK, a prospective randomized study was undertaken, aimed mainly at evaluating coronary myocardial blood flow in the infarcted myocardium using Tl-201 myocardial scintigraphy. 166 patients (131 male and 35 female, mean age 61.1 years) with AMI classified in Killip I or II who were admitted to the CCU within 24 hours of the onset of symptoms were divided into two groups; 76 patients treated with UK (UK group) and 90 patients treated with conventional therapy without UK (control group). Intravenous UK 72,000 IU was injected over 10 minutes and UK 528,000 IU was subsequently given by drip infusion over the following 12 (n = 36) or 24 hours (n = 40). There was no significant difference between the two groups with regard to the patients' background. Tl-201 uptake of infarcted myocardium in the UK group (n = 17) significantly increased in the first week compared with that on the day of admission (p less than 0.005) and a further significant increase was observed in the fourth week (p less than 0.05). In the control group (n = 10) Tl-201 uptake did not change in the first week and then increased significantly in the fourth week (p less than 0.05). Coronary angiography and left ventriculography (43 cases in the UK group and 32 cases in the control group) performed in the convalescent stage of AMI showed: 1) similar prevalence of patency of the infarct related artery (UK group: 72.1%, control group: 75.0%), 2) more prominent collateral circulation in the UK group (62.9% vs 41.4%), 3) significantly better perfusion of infarcted myocardium by coronary antegrade flow and/or collateral flow in the UK group (70.0% vs 46.9%, p less than 0.05), 4) a trend towards reduction of severe asynergy in the infarcted regional wall of the left ventricle in the UK group (16.3% vs 34.4%). The mortality rate of patients with first AMI in the UK group (n = 66) was significantly lower than that in the control group (n = 68) (4.5% vs 14.7%, p less than 0.05), and a similar trend was also found in patients with prior infarction (UK: n = 10, 0% vs control: n = 22, 13.6%).(ABSTRACT TRUNCATED AT 400 WORDS)
 ...
PMID:[A study of a systemic fibrinolytic treatment of acute myocardial infarction. The effect of a moderate dose infusion of urokinase]. 191 75

To determine the clinical significance of regional left ventricular asynergy in patients with impending myocardial infarction, we recorded two-dimensional echocardiograms (2DE) serially and performed coronary angiography immediately after the hospital admission in nine patients with initial impending infarction and their last anginal attacks were within 48 hours. Left ventricular asynergy on the first 2DE was observed in six of nine patients during symptom-free periods (Group A: LV asynergy group). Five of the six patients had significant coronary artery lesions (greater than or equal to 75% stenosis) in at least one major coronary artery. Intracoronary filling defects were detected in four of the five patients. Another three patients without asynergy (Group B) had significant fixed stenosis. Coronary artery spasm was observed in two patients during coronary angiography, but no patient had intracoronary filling defects. Intracoronary nitroglycerin (0.1-0.3 mg) reduced the severity of coronary artery narrowing in two patients. In addition, urokinase (240,000-480,000 IU) via the corresponding vessel (PTCR) in the remaining seven patients resulted in reduction in the severity of coronary artery stenosis in four patients, but not in the remaining three patients. Left ventricular wall movement in the asynergy group improved rapidly and no asynergy was observed by the seventh hospital day in five of the six patients. Successful PTCR treatment resulted in improvement of left ventricular wall movement. No asynergy was found in the non-asynergy group throughout their hospitalizations. These findings indicated that abnormal left ventricular wall movement is found in patients with impending myocardial infarction, even during symptom-free periods, but the wall movement gradually improves. The 2DE observations are useful for estimating the clinical status and for planning precise therapy for impending myocardial infarction.
 ...
PMID:[Left ventricular asynergy in patients with impending myocardial infarction: two-dimensional echocardiographic assessment]. 350 98

Myocardial metabolism was assessed in 20 patients with acute anterior myocardial infarction using lactate uptake (defined as (aortic lactate - great cardiac venous lactate)/aortic lactate X 100) as an index. The regional ejection fraction of the anterior wall was obtained from left ventriculography. There was a linear relation between lactate uptake and regional ejection fraction (r = 0.79, p less than 0.001). Four patients without total occlusion in the infarct vessel had a higher lactate uptake (19.6 +/- 6.7 versus 4.2 +/- 13.4%, p less than 0.05) and regional ejection fraction (26.3 +/- 7.9 versus 14.9 +/- 7.0%, p less than 0.05) than did 16 patients with total occlusion. The latter group of patients underwent intracoronary infusion of urokinase, which resulted in reperfusion in 13 patients. Lactate uptake before urokinase infusion (sample I), just after reperfusion (sample II), 30 minutes after reperfusion (sample III) and 4 weeks after reperfusion (sample IV) was 5.7 +/- 13.2, -13.9 +/- 14.7, 2.9 +/- 15.2 and 20.2 +/- 11.0%, respectively (sample I versus II and II versus III, p less than 0.01; sample I versus IV and III versus IV, p less than 0.05). The decrease in lactate uptake immediately after reperfusion, which was accompanied by an increase in creatine kinase-MB isoenzyme release into the blood, was considered to be the result of a "washout" effect. Lactate uptake was ameliorated 4 weeks later, accompanied by an improvement (from 15.1 +/- 7.1 to 23.4 +/- 7.2%, p less than 0.01) in the regional ejection fraction. It is concluded that the degree of asynergy was closely related to the extent of metabolic deterioration in myocardial infarction.
 ...
PMID:Lactate metabolism in acute myocardial infarction and its relation to regional ventricular performance. 399 12