Thrombolytic therapy in acute myocardial infarction in the elderly
Related Experiment Videos
F A Johnston1, F G Dunn, K J Hogg
1Coronary Care Unit, Stobhill Hospital, Glasgow, UK.
Insights
Successful thrombolytic therapy for acute myocardial infarction in elderly patients achieved a 77% reperfusion rate, significantly reducing mortality. Early non-invasive markers accurately predicted reperfusion success.
Area of Science:
- Cardiology
- Emergency Medicine
- Pharmacology
Background:
- Acute myocardial infarction (AMI) is a leading cause of mortality in the elderly.
- Thrombolytic therapy is a critical treatment for AMI, aiming to restore coronary blood flow.
- Early reperfusion is associated with improved patient outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of thrombolytic therapy in elderly patients with AMI.
- To identify non-invasive markers predictive of successful coronary artery reperfusion.
- To assess the impact of reperfusion on short-term and long-term mortality.
Main Methods:
- Fifty-seven elderly patients (65-80 years) with AMI received thrombolytic therapy (streptokinase or anisoylated plasminogen streptokinase activator complex) within 8 hours.
- Coronary arteriography confirmed reperfusion.
- Non-invasive markers including ST-segment changes, creatine phosphokinase (CPK) peak, and arrhythmias were monitored.
- Clinical events, bleeding complications, and mortality at 1 month and 1 year were recorded.
Main Results:
- An overall reperfusion rate of 77% was achieved.
- Accurate non-invasive markers included rapid ST-segment fall, early CPK peak, and reperfusion arrhythmias.
- Early reocclusion occurred in 30% of patients.
- Mortality at 1 month was 6.6% for reperfused patients versus 38% for non-reperfusion/reocclusion.
- One-year mortality was 10% for reperfused patients versus 46% for non-reperfusion/reocclusion.
Conclusions:
- Thrombolytic therapy is effective in achieving coronary reperfusion in elderly patients with AMI.
- Non-invasive markers can reliably indicate successful reperfusion.
- Successful reperfusion significantly reduces short-term and long-term mortality in this patient group.
Abstract:
Fifty-seven elderly patients (35 males, 22 females; age range 65-80 years, mean 70 years) with acute myocardial infarction received thrombolytic therapy within 8 h using either streptokinase or anisoylated plasminogen streptokinase activator complex. Coronary artery reperfusion was confirmed by early coronary arteriography. The overall reperfusion rate was 77%. Accurate non-invasive markers of reperfusion included: a rapid fall in the S-T segment elevation, an early peak of the creatinine phosphokinase enzyme curve and reperfusion arrhythmias. Clinical events suggesting early reocclusion occurred in 30%. Coronary arteriography was accompanied by local bleeding associated with the arterial puncture site in 2 patients and a cerebrovascular accident in 1 patient. Minor bleeding occurred in 6 other patients. In those where reperfusion occurred, the mortality at 1 month was 6.6% and in those who did not reperfuse or had early reocclusion 38%. At 1 year the figures were 10 and 46%, respectively.