[System thrombolytic therapy in acute myocardial infarction in the elderly]

The paper presents a retrospective cohort study of the records of 430 patients with myocardial infarction aged 60 to 91. Group I (main group) consisted of 234 patients who received system thrombolytic therapy (TLT); group II (controls) consisted of 196 patients who received conventional therapy. Hospital and long-term lethality, the course of the disease, and the complications of thrombolysis were evaluated. The study found no effect of TLT itself on the end points; there were differences between subgroups with effective and non-effective thrombolysis. Thus, comparison of these variables in patients aged 60 to 74 showed a decrease in the hospital lethality in the main group: 6.6% vs. 20.6% in the control group (p = 0.00072), and an increase in five-year survival (p = 0.0057). Cardiac arrhythmias (CA) and chronic heart failure were much less frequent in group I. Transient hypotension occurred in 36% of patients on thrombolytic therapy; reperfusion-related CA were noted in 25% of patients receiving thrombolysis. There were no cases of serious hemorrhage or cerebral strokes. None of the complications resulted in a lethal outcome. The study demonstrates that TLT is not contra-indicated in the elderly with myocardial infarction; complications are, as a rule, insignificant and easily reversible. When reperfusion is successful, thrombolysis lowers early and long-term lethality and improves the course of the disease in this very complex category of patients.