Incidence of Neurological Syndromes After Thrombolytic Therapy In Elderly Patients With Acute Myocardial Infarction

Abstract

Background: Reperfusion therapy is the standard treatment of acute myocardial infarction (AMI). If the percutaneous coronary intervention (PCI), as a preferred reperfusion strategy, was not available, thrombolytic therapy is chosen as an alternative treatment. However, the affect of thrombolytic therapy in old patients is still controversial; especially because of its effects on increasing the incidence of intra cranial hemorrhage (ICH). In this study, we evaluated the incidence of neurological symptoms and ICH after thrombolytic therapy in more than 65 years old patients with AMI. Methods: 300 patients of 65 years old and more with AMI in which their symptoms had been begun more than 12 hours before admission to the hospital, and with no contraindications for receiving thrombolytic therapy, were chosen. The patients were admitted in Noor hospital between 2004 and 2006. All of them received streptokinase (SK) in the same way, and the information's were pulled out from their files and gathered in a check list. Findings: Among 300 patients in our study, there were 124 women (41/33%) and 176 men (58/66%). Their mean age was (74±9) years (from 65 to 92 years). 78% were discharged after one week hospitalization and 22% (66 patients) died. Arrhythmias or myocardial re-infarction were the leading cause of death in 56/06% of all deaths. No death due to ICH and no evidence of ICH, such as hemi-paresis or loss of consciousness, were occurred. Conclusion: We suggest that thrombolytic therapy in old patients with acute myocardial infarction is a good alternative treatment when there is no ready access to a skilled PCI facility. In our study, increasing of mortality rate due to ICH was not enough to exclude giving SK to more than 65 years old patients. Key words: Acute myocardial infarction, percutaneous coronary intervention, intracranial hemorrhage, streptokinase, thrombolytic therapy