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Fibrinolytic therapy in patients 75 years and older with ST-wegment–elevation myocardial infarction: one-year follow-up of a large prospective cohort
Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences.
Department of Cardiology, University Hospital of Uppsala, Uppsala, Sweden.
2003 (English)In: Archives of Internal Medicine, ISSN 0003-9926, E-ISSN 1538-3679, Vol. 163, no 8, 965-971 p.Article in journal (Refereed) Published
Abstract [en]

Background  Fibrinolytic therapy reportedly may not be beneficial in acute ST-segment–elevation myocardial infarction (STEMI) in patients who are 75 years and older.

Methods  The association between fibrinolytic therapy and 1-year mortality and bleeding complications in an unselected large cohort of patients with STEMI was evaluated by means of propensity and Cox regression analysis adjusting for multiple factors known to influence fibrinolytic therapy as well as survival. The Register of Information and Knowledge About Swedish Heart Intensive Care Admissions recorded every patient admitted to a coronary care unit in 64 hospitals during 1995 through 1999. One-year mortality was obtained by merging with the National Cause of Death Register.

Results  A total of 6891 patients 75 years and older with first registry-recorded STEMI were included, of whom 3897 received fibrinolytic therapy and 2994 received no such treatment. Fibrinolytic therapy was associated with a 13% adjusted relative reduction in the composite of mortality and cerebral bleeding complications after 1 year (95% confidence interval, 0.80-0.94; P = .001). This effect seemed homogeneous among all subgroups based on age, sex, coronary risk factors, and previous disease manifestations.

Conclusions  Fibrinolytic therapy in patients with STEMI who are 75 years and older is associated with a reduction in the composite of mortality and cerebral bleedings after 1 year. These results from an unselected coronary care unit population support the use of fibrinolytic therapy in elderly patients.

Place, publisher, year, edition, pages
2003. Vol. 163, no 8, 965-971 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-46621DOI: 10.1001/archinte.163.8.965OAI: diva2:267517
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2012-09-19Bibliographically approved
In thesis
1. Improving outcome in acute myocardial infarction
Open this publication in new window or tab >>Improving outcome in acute myocardial infarction
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Despite common guidelines there are vanatlons in the treatment of acute myocardial infarction (AMI) between hospitals in Sweden. Uncertainties remain regarding the efficacy of early statin therapy and early revascularisation in AMI patients. In the elderly patients also the role of fibrinolytic therapy has been questioned.

Methods: We created a national quality assurance register named RIKS-HIA including all patients admitted to participating hospitals' ICCU. The database accumulates information about baseline characteristics, interventions, complications and outcome in consecutive patients. The merging of the database with the Cause of Death Register provides  opportunity to compare the effects of treatments on long-term outcome. Multivariate Cox regression analysis and propensity score was used to evaluate outcome in AMI patients of the studied interventions, and to compare activity level between different hospitals.

Results: After patient characteristics were taken into account there were still significant differences between the hospitals in some treatment modalities that remained over time. There was no correlation between hospital size and activity level. In 19 599 in-hospital survivors after their first registry-recorded AMI at an age below 80 years early statin treatment was associated with a 25 % relative risk reduction of I-year mortality. In 21 912 patients with first registry-recorded AMI younger than 80 years and alive at day 14, early revascularisation was associated with a 50 % relative reduction of I-year mortality. For both therapies the effects were homogeneous among all subgroups based on age, gender, baseline characteristics, previous disease manifestations and medication. Fibrinolytic therapy in ST-segment elevation myocardial infarction patients 75 years of age and older showed a net benefit of 13% in outcome when non-fatal intracranial haemorrhage and I-year survival were analysed.

Conclusion: The results indicates the need of continuous quality assurance, and strategies to reduce the differences in AMI therapy between hospitals. They lend support to early statin and early revascularisation regimens in AMI patients. Fibrinolytic therapy is recommended also in the elderly patients.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2002. 73 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 740
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-27543 (URN)12202 (Local ID)91-7373-189-7 (ISBN)12202 (Archive number)12202 (OAI)
Public defence
2002-11-07, Elsa Brändströmsalen, Campus US, Linköpings universtiet, Linköping, 13:00 (Swedish)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-19Bibliographically approved

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