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Abstract

Introduction: The emergent pharmacologic reperfusion of elderly patients with STEMI, although not formally contraindicated in clinical guidelines, can still be a challenge for intensive care providers. Clinical outcomes in elderly patients have not been described in comparison to younger populations. Methods: This was a retrospective study which analyzed all patients admitted with STEMI that received in-hospital fibrinolysis in a secondary care hospital between April 1999 - June 2012 (504 patients). Among them 85 cases (75 and over) and 85 controls ( <75 years old) were randomized. 9 descriptive and 17 analytic (evolution and prognosis) variables were analyzed. Statistic methods used: average ± standard deviation for the descriptive variables and t test or χ2/Fisher Test for the analytic variables. Significant results were considered with a p value <0.05. Results: Elderly patients who received fibrinolysis had higher risk of bleeding per Crusade Score (38.2 ± 13.5 vs 22.8 ± 12), higher delay until reperfusion (232 ± 153 vs 156 ± 107 minutes) and lower incidence of 2 or 3 coronary vessel disease (17.3% vs 26.6%). Concerning complications and evolution, we noted a higher incidence of acute renal injury (24% vs 2.6%), Killip III-IV class (21.3% vs 6.6%), relevant arrhythmias (45.3% vs 22.6%), heart failure (33.3% vs 6.6%), stroke (5.3% vs 0%) and cardiac tamponade (2.6% vs 0%) comparing among cases, as well as a higher mortality in the ICU, in-hospital and at 6 months postSTEMI. No significant differences were appreciated in the post-infarction ejection fraction, ICU stay, previous NYHA class or at 6 months postSTEMI. Conclusions: Elderly patients with STEMI treated with fibrinolysis have significantly greater negative outcomes when compared to younger patient populations including acute renal injury, significant arrhythmias, heart failure and higher mortality both in the ICU and at 6 months.