Resolution of ST-segment elevation after thrombolytic therapy in elderly patients with acute myocardial infarction.
We examined the resolution of ST-segment elevation after thrombolytic therapy in elderly versus younger patients with acute myocardial infarction. Electrocardiograms were recorded before, on completion of, and on day 1 and day 2 post-thrombolytic therapy (streptokinase or tissue thromboplastin activator) in 36 patients older than 65 years and 36 patients younger than 65 years. There was no significant different in the pre-thrombolytic ST-segment elevation per lead in both elderly and younger patients (3.7 +/- 0.7 versus 3.5 +/- 0.8 mm; P = NS). On completion of thrombolytic therapy, both groups demonstrated resolution of ST-segment elevation and, although the ST-segment elevation per lead was higher in elderly patients (3.0 +/- 0.9 versus 2.5 +/- 0.9 mm; P = 0.008), the percentage resolution per lead was not significantly different (19% versus 29%; P = NS). On day 1 post-thrombolytic therapy, there was further resolution of ST-segment elevation in both groups, but at this point, the percentage resolution per lead was significantly less in the elderly than in the younger patients (51% versus 66%; P = 0.03), and the ST-segment elevation per lead remained higher in elderly patients (1.8 +/- 1.0 versus 1.2 +/- 0.6 mm; P = 0.0009). On day 2 post-thrombolytic therapy, although there was further resolution of ST-segment elevation in both groups, the percentage resolution per lead remained significantly less (68% versus 80%; P = 0.05) and ST-segment elevation per lead remained significantly higher in elderly patients (1.2 +/- 0.7 versus 0.7 +/- 0.4 mm; P = 0.0002). Resolution of ST-segment elevation after thrombolytic therapy was less marked in elderly patients, indicating a reduced response to thrombolytic therapy in this patient population.
Mehta
Nirav J
NJ
Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Cardiac Center, 3006 Webster Street, Omaha, NE 68131-2044, USA.
Mehta
Rajal N
RN
Khan
Ijaz A
IA
D000367:Age Factors; D000368:Aged; D004562:Electrocardiography / Q000187:drug effects*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006329:Heart Conduction System / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000627:therapeutic use*; D020127:Recovery of Function / Q000187:drug effects; D012189:Retrospective Studies; D013300:Streptokinase / Q000008:administration & dosage / Q000627:therapeutic use*; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D013300:Streptokinase; D010960:Plasminogen Activators