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Resolution of ST-segment elevation after thrombolytic therapy in elderly patients with acute myocardial infarction
Nirav J Mehta1, Rajal N Mehta, Ijaz A Khan
1Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Cardiac Center, 3006 Webster Street, Omaha, NE 68131-2044, USA.
Insights
Elderly patients showed less ST-segment elevation resolution after thrombolytic therapy for acute myocardial infarction. This indicates a reduced response to thrombolytic therapy in older individuals compared to younger ones.
Area of Science:
- Cardiology
- Geriatric Medicine
- Pharmacology
Background:
- Acute myocardial infarction (AMI) is a leading cause of mortality worldwide.
- Thrombolytic therapy is a cornerstone treatment for AMI, aiming to restore blood flow.
- Age is a significant factor influencing treatment response and outcomes in cardiovascular diseases.
Purpose of the Study:
- To compare the resolution of ST-segment elevation after thrombolytic therapy in elderly versus younger patients with acute myocardial infarction.
- To assess the efficacy of thrombolytic agents in different age groups.
Main Methods:
- Prospective study involving 72 patients (36 elderly >65 years, 36 younger <65 years) with AMI.
- Electrocardiograms (ECGs) were recorded before, during, and up to 2 days post-thrombolytic therapy (streptokinase or tissue plasminogen activator).
- ST-segment elevation (STE) and its resolution were quantified per lead and as a percentage of initial elevation.
Main Results:
- No significant difference in pre-thrombolytic STE between elderly and younger patients.
- While both groups showed STE resolution, elderly patients had higher residual STE (3.0 vs 2.5 mm, P=0.008) and lower percentage resolution (19% vs 29%, P=NS) immediately post-therapy.
- On day 1 and day 2 post-therapy, elderly patients consistently showed significantly less percentage resolution (Day 1: 51% vs 66%, P=0.03; Day 2: 68% vs 80%, P=0.05) and higher residual STE (Day 1: 1.8 vs 1.2 mm, P=0.0009; Day 2: 1.2 vs 0.7 mm, P=0.0002).
Conclusions:
- Resolution of ST-segment elevation following thrombolytic therapy is less effective in elderly patients compared to younger patients.
- These findings suggest a diminished response to thrombolytic therapy in the elderly population with acute myocardial infarction.
- Further research may be warranted to optimize treatment strategies for older adults experiencing AMI.
Abstract:
We examined the resolution of ST-segment elevation after thrombolytic therapy in elderly versus younger patients with acute myocardial infarction. Electrocardiograms were recorded before, on completion of, and on day 1 and day 2 post-thrombolytic therapy (streptokinase or tissue thromboplastin activator) in 36 patients older than 65 years and 36 patients younger than 65 years. There was no significant different in the pre-thrombolytic ST-segment elevation per lead in both elderly and younger patients (3.7 +/- 0.7 versus 3.5 +/- 0.8 mm; P = NS). On completion of thrombolytic therapy, both groups demonstrated resolution of ST-segment elevation and, although the ST-segment elevation per lead was higher in elderly patients (3.0 +/- 0.9 versus 2.5 +/- 0.9 mm; P = 0.008), the percentage resolution per lead was not significantly different (19% versus 29%; P = NS). On day 1 post-thrombolytic therapy, there was further resolution of ST-segment elevation in both groups, but at this point, the percentage resolution per lead was significantly less in the elderly than in the younger patients (51% versus 66%; P = 0.03), and the ST-segment elevation per lead remained higher in elderly patients (1.8 +/- 1.0 versus 1.2 +/- 0.6 mm; P = 0.0009). On day 2 post-thrombolytic therapy, although there was further resolution of ST-segment elevation in both groups, the percentage resolution per lead remained significantly less (68% versus 80%; P = 0.05) and ST-segment elevation per lead remained significantly higher in elderly patients (1.2 +/- 0.7 versus 0.7 +/- 0.4 mm; P = 0.0002). Resolution of ST-segment elevation after thrombolytic therapy was less marked in elderly patients, indicating a reduced response to thrombolytic therapy in this patient population.