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Comparison of effects of thrombolytic therapy on left ventricular function in patients over with those under 60 years
Insights
Thrombolytic therapy significantly improves left ventricular (LV) function after acute myocardial infarction in both younger and older patients. Older individuals may experience greater benefits from this treatment, despite a slightly higher risk of bleeding complications.
Area of Science:
- Cardiology
- Geriatric Medicine
- Pharmacology
Background:
- Acute myocardial infarction (AMI) impacts left ventricular (LV) function.
- Age is a significant factor influencing recovery and outcomes post-AMI.
- Thrombolytic therapy is a critical intervention for AMI.
Purpose of the Study:
- To investigate the effect of age on LV function following AMI.
- To assess the efficacy of thrombolytic therapy in different age groups.
- To determine if age independently influences LV function post-thrombolysis.
Main Methods:
- Contrast ventriculography was used to assess LV function 3 weeks post-AMI.
- Patients were stratified into two age groups: <60 years and >=60 years.
- Comparison between thrombolytic therapy (streptokinase, rt-PA) and placebo groups was performed.
Main Results:
- Thrombolytic therapy improved ejection fraction (EF) in both younger (54% to 59%) and older (50% to 57%) patients.
- Age and thrombolytic therapy were independently associated with improved EF.
- End-systolic volume decreased with thrombolysis in both age groups, with a larger reduction in the elderly.
- Increased minor bleeding was observed in older patients, with 3 serious hemorrhages in the >=60 group.
Conclusions:
- Thrombolysis enhances LV function across all studied age groups after AMI.
- Older patients, despite potential increased bleeding risk, show significant LV function improvement.
- Age is an independent predictor of lower EF post-AMI, suggesting greater therapeutic benefit from thrombolysis in the elderly.
Abstract:
This study examined the effect of age on left ventricular (LV) function, assessed by contrast ventriculography 3 weeks after a first acute myocardial infarction in 312 patients who received thrombolytic therapy within 4 hours of the onset of infarction and in 83 patients who received placebo. Streptokinase was given to 188 patients and recombinant tissue-type plasminogen activator (rt-PA) to 124. Patients were divided into 2 age groups: less than 60 years (n = 244) and greater than or equal to 60 years (n = 151). Thrombolytic therapy improved ejection fraction in both age groups: from 54 +/- 13 to 59 +/- 11% (p = 0.021) in the younger group and from 50 +/- 14 to 57 +/- 13% (p = 0.004) in the older group. Ejection fraction was identical in streptokinase- and rt-PA-treated patients. Multifactor analysis of variance revealed that younger age and thrombolytic therapy were independently associated with improved ejection fraction. Thrombolytic therapy also reduced end-systolic volume (p = 0.001) by 14 ml in the elderly and 9 ml in the younger group. Minor bleeding complications were more frequent in the elderly and 3 serious hemorrhages occurred in patients greater than or equal to 60 years. These findings reveal that thrombolysis improves LV function in all age groups studied. Because increasing age is independently associated with a lower ejection fraction after acute myocardial infarction, thrombolytic therapy may confer greater benefits in older patients.