Primary angioplasty versus streptokinase in elderly patients with acute myocardial infarction

cc1335 CCJ Meeting abstract Primary angioplasty versus streptokinase in elderly patients with acute myocardial infarction Leite PF Park M Kawabata VS Barduco MS Timerman S Cardoso LF Ramires JAF

Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil

Critical Care First International Symposium on Intensive Care and Emergency Medicine for Latin America: Meeting abstracts First International Symposium on Intensive Care and Emergency Medicine for Latin America: São Paulo, Brazil

26–29 June 2001

1364-8535 2001 5 Suppl 3 P2 10.1186/cc1335 26 6 2001 cc-5-s3-p02

Because only a few studies about acute myocardial infarction (AMI) include elderly patients, we compared outcomes of patients aged 70 years or older with AMI who underwent thrombolysis or primary angioplasty treatment.

Methods

From April 1995 to June 1999, 64 patients within 12 h of symptom onset and no contraindications for thrombolytic therapy were randomized in two groups. Group I (32 patients, 20 men) submitted to an infusion of 1.5 million units of intravenous streptokinase (SK) and group II (32 patients, 17 men) to primary angioplasty (PA). Primary end-points included incidence of death, reinfarction, stroke, or readmission after 6 months follow up. Baseline characteristics of the two groups did not show significant differences.

Results

Clinical results are shown in the Table. The success rate (residual stenosis less than 50% and TIMI3 flow) in group II was 86%. Group I patients were 1.5 times more likely to have combined end-points (95% CI 0.89-2.40; P = 0.21).

Table

SK (n = 32)

PA (n = 32)

Pain onset-presentation (min)^*

180 (90/360)

180 (120/291)

Presentation-treatment (min)^*

45 (22/60)

105 (70/175)

0.0002

Reinfarction/stroke/readmission (%)

2/0/5 (22)

6/1/1 (25)

Death 6 months (%)

12 (37.5)

6 (19)

0.16

Combined end-points (%)

18 (56)

12 (37.5)

0.21

Complications from catheter (%)

5/27 (19)

9/32 (28)

0.54

Treatment (clinic/revasc)

16/16

7/25

0.036

Time of hospital (days)^*

8 (2/16)

8 (6/15)

^*Data presented are median (25^th, 75^th centiles).

Conclusion

These findings suggest that in elderly patients eligible for thrombolytic therapy, primary angioplasty and SK were safe. The two methods of reperfusion were comparable according to these end-points during the follow up. The delay to perform primary angioplasty may be one of the causes of these findings.