A study on clinical profile and in-hospital outcome of elderly patients receiving thrombolytic therapy for ST elevation myocardial infarction

Abstract

Objective: Ischemic heart disease is the leading cause of mortality in population above the age of 70 years. ST-elevation myocardial infarction (STEMI) constitutes important treatable cause of death in elderly population. However, many large, randomized trials have excluded this age group. The present study was planned to find out the benefits and complications related to thrombolytic therapy in elderly patients. Materials and Methods: The study was done between January 1, 2019, and December 31, 2019, in the Department of Cardiology, Sri Jayadeva Institute Of Cardiovascular Sciences and Research, Bengaluru, India, which included the study group comprising 106 elderly patients (age >70 years) with acute STEMI and underwent thrombolytic therapy. All patients were followed up till the index hospitalization and evaluated for in-hospital outcome. Results: Out of the 106 patients in the study group, 64 (60.38%) were male and 42 (39.62%) were female. Out of which, 88 (83%) patients were between 70 and 80 years whereas 18 (17%) patients were >80 years. Mortality was happened in 32 patients (30.2%). Coronary angiogram post thrombolysis was performed as pharmacoinvasive or rescue percutaneous coronary intervention (PCI) in 25 patients (23.6%), and cardiac arrhythmias were noted in 22 (20.6%) patients, acute kidney injury in 7 (6.6%) patients, ventricular septal rupture in 5.7%, ischemic stroke in 4.7%, free-wall rupture in 2.8%, and intracranial hemorrhage in 0.9% of patients. Conclusions: Primary PCI may offer clinical advantage over fibrinolytic therapy as manifested by the trends toward improvements in the combined endpoint of death, reinfarction, and stroke in the oldest patients. Despite the higher prevalence of comorbidities and high-risk features in elderly patients of acute STEMI, timely thrombolysis is also beneficial particularly who present early after symptom onset, absence of comorbid condition, and lower NYHA class on admission (NYHA I/II). In developing countries like India where primary PCI may not be feasible, timely thrombolysis should be given to the elderly patients also.