Thrombolytic therapy in acute myocardial infarction in the elderly

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.