Thrombolytic Therapy of Acute Myocardial Infarction in Elderly Patients. Immediate and Long-Term Remote Prognosis
Aim. To study effects of thrombolytic therapy in elderly patients. Material and methods. One hundred twenty three patients with acute myocardial infarction were admitted within first 12 hours of myocardial infarction, 66 of them were subjected to thrombolytic therapy with streptokinase (group 1) while 57 were not because of contraindications (group 2). In group 1 age of 49 patients was 66-75 years, and that of 17 patients exceeded 75 years. Results. In 24.2% of patients pain ceased during thrombolysis. This effect occurred less often in patients over 75 years of age. Reperfusion arrhythmias were registered in 15.1% of older patients. Patients of group 2 more often had acute left ventricular failure (47.4% vs. 18.2% in group 1, p=0.003). Rate of development of acute heart failure was higher in patients aged over 75 years (by 8% compared with younger patients in both groups). Chronic heart failure developed in 36.8% and 13.6% of patients in group 2 and 1, respectively (p=0.001). Rate of chronic heart failure in group 1 was lower than among total population of patients, subjected to thrombolytic therapy (13.6 and 26.5%, respectively, p=0.040). Rate of early angina and reinfarction was higher in group 1 than in group 2 (by 4 and 3%, respectively). In 12 months rate of angina was higher in group 1 compared with group 2 (83.3 and 52.6%, respectively, p=0.088). Among patients with heart failure in group 1 prevailed those with class I-II (p=0.175) while in group 2 there were more patients with class III-IV than class I-II heart failure. Rate of chronic heart failure among patients older than 75 years was by 13 and 22.8% higher, than in younger patients of groups 1 and 2, respectively. One year mortality was 9.1% in group 1 and 22.8% (p=0.019) in group 2. Mortality among patients over 75 years of age was higher in both groups especially in group 1 (by 13.5%).