The Study Of Emergency Intracoronary Stenting And Thrombolytie Therapy In Elderly Patients With Acute Myocardial Infarction

Objective To compare the clinical therapeutic efficacy of emergency intracoronary stenting and thrombolytic therapy in elderly patients with acute myocardial infarction (AMI). Methods 57 elderly AMI patients were admitted to our hospital from January 1999 to December 2003 .Their ages were from 65 to 90. The average age was 70.91±5.49. Of them, except 4 elderly AMI patients complicated by cardiac shock directly underwent emergency intracoronary stenting, 53 elderly AMI patients, according to their desires, were divided into emergency intracoronary stenting group (stent group) and thrombolytic therapy group (thrombolytic group). Stent group underwent coronary angiography, percutaneous transluminal coronary angioplasty (PTCA) and stenting in infarction related arteries (IRA). Thrombolytic group underwent thrombolytic therapy with urokinase (100 0000-200 0000IU). The efficacy of stent group was estimated by the blood flow of TIMI (Thrombolysis in myocardial infarction) grade. The efficacy of thrombolytic group was indirectly estimated by clinical standard. Left ventricular ejection fraction (LVEF) was measured with two-dimensional echocardiography before being discharged from hospital, and major cardiac events were recorded. The patients were followed up in the periods of 1-3 years, and major cardiac events were recorded. Results The age, gender, onset of chest pain, location of AMI, Killip class in the two groups were not significantly different (P>0.05). All of IRA in the stent group was successful revascularized (100%). The rate of clinical success was 92%. The rate of clinical success in thrombolytic therapy was 67.90%. There was significant difference in the two groups (p<0.05). The time from the onset of chest to hospitalization was no significant difference in the two groups. The time from hospitalization to intervention in the stent group was longer than that from hospitalization to thrombolytic in the thrombolytic group (P<0.01). The time from hospitalization to alleviation and the time from onset to alleviation in the stent group were shorter than that in the thrombolytic group (P<0.05). The hospitalization days in the stent group were shorter than that in the thrombolytic group (P<0.01). The LVEF in the period of hospitalization was no significant difference in the two groups (P>0.05). Major cardiac events in the period of hospitalization time were not significantly different in the two groups (P>0.05). There were 2 cases with upper gastrointestinal hemorrhage, 3 with acute coronary reocclusion, 3 with heart failure and 2 deaths in the stent group. There were 1 case with upper gastrointestinal hemorrhage, 5 with heart failure and 5 deaths in the thrombolytic group .The rate of resuming normal life after 3 months in the stent group was higher than that in the thrombolytic group (P<0.001). The occurrence of angina in the stent group was less than that in the thrombolytic group in the half a year (P<0.001). The occurrence of major cardiac events in the period of following up was no significant difference in the two groups. The successful rate of elderly AMI patients complicated by cardiac shock was 25%. Conclusion Emergency intracoronary stenting is safe and effectual for elderly AMI because of its higher rate of revascularization and shorter hospitalization days.