One-Year Follow-up of Patients Treated with Prolonged Low-dose of rt-P for Refractory Unstable Angina

We have previously shown an in-hospital beneficial effect of prolonged thrombolysis with rt-P in patients with refractory unstable angina. The aim of this study was to assess whether the short term effect of this therapy is sustained after one year. The study population included 67 patients (pts) with unstable angin refractory to common antianginal therapy. Thirty-six pts (group A) were randomized to receive rt-P (0.03 mg/kg/hour for 3 consecutive days) plus heparin (ACT 250-400 sec), and 31 pts to receive heparin (ACT 250-400 sec) plus placebo infusion. Both groups also received conventional therapy with nitrates, β-blockers and Calcium channel blockers. One pt of group and 4 of group B (3% vs 13%, p < 0.01) developed acute myocardial infarction during hospitalisation. Eight pts of group B underwent coronary artery surgery because of persistence of symptoms during hospitalization. Group B pts more frequently shown recurrent angin (8% vs 19%, p < 0.05) and total ischemic burden >60 min/day on ambulatory ECG monitoring (8% vs 19%, p < 0.05). After mean follow up of 14 ± 6 months 3 pts from group and 7 pts from group B suffered an acute myocardial infarction (9% vs 30%, p < 0.05). Seven patients died for cardiac related causes (3 in group and 4 in group B), 38 patients (20 in group and 18 in group B, 57% vs 78.3%) underwent PTC or CABG. Eight pts from group and 1 patient from group B (23% vs 4% p < 0.05) remained angin free on medical therapy. In conclusion, the benefits of prolonged low-dose of rt-P for refractory unstable angin persist for at least one year.