Efficacy of thrombolytic therapy and analysis of related factors of hospital death in elderly patients with acute ST-segment elevation myocardial infarction
Liu Xinyun
Xing Wenlu
Jiang Jicheng
Zhang You
Wang Shan
Zhang Hua
Gao Chuanyu
Abstract：Objective To investigate the efficacy of thrombolytic therapy in elderly patients with acute ST-segment elevation myocardial infarction(STEMI)and evaluate the factors affecting hospital death.Methods 1226 patients with acute STEMI were continuously enrolled from 73 hospitals in Henan Province,and reteplase was used for thrombolytic therapy.The differences in infarct vessel recanalization rates,cardiovascular events,and bleeding events were compared between acute STEMI patients aged＜65 years and≥65 years.The differences in various factors between the death and the survival groups of elderly patients with acute STEMI were compared,and the relevant factors of the difference were analyzed by multivariate Logistic regression.Results 7 patients who died during thrombolysis were excluded and 1219 patients with acute STEMI were finally analyzed.The patients aged＜65 years accounted for 899 cases(73.7%),and those aged≥65 years accounted for 320 cases(26.3%).The recanalization rates of infarcted vessels were 89.4%and 89.1%in patients aged<65 years and those aged≥65 years,respectively(P=0.85).Compared with those aged<65 years,patients aged≥65 years had higher rates of mortality after thrombolysis(1.6%vs.4.7%,P=0.002),heart failure and shock(both 0.8%vs.2.2%,P=0.04)during hospitalization.In the group of patients aged≥65 years,15 cases(4.7%)died and 95.3%(305 cases)survived in hospital.Compared with hospitalized surviving elderly patients(≥65 years),the proportion of men and the recanalization rate of infarcted vessels were lower;The level of Killip classification and rates of heart failure,shock and reinfarction were higher in elderly patients who died in hospital(P<0.05).With multivariate logistic regression analysis,females(OR=3.54,95%CI:1.09～11.43)and high Killip grades(OR=1.72,95%CI:1.00～2.94)were associated with a higher risk of death in elderly patients.Recanalization was associated with a lower risk of death in elderly patients(OR=0.07,95%CI:0.02～0.21).Conclusion Thrombolysis can be used as an early reperfusion therapy for elderly patients with acute STEMI.Compared with patients aged＜65 years,those aged≥65 years have a higher hospital mortality rate after thrombolysis.Females and higher Killip grades are risk factors affecting hospital deaths.
Keywords：Myocardial infarctionThrombolysisElderlyDeath
Publication Date：2023-10-28
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 1194-1198 )