FIBRINOLYSIS OF ST ELEVATION MYOCARDIAL INFARCTION IN EMERGENCY DEPARTMENT: PROGNOSIS OF ELDERLY PATIENTS TREATED WITH STREPTOKINASE

• Hela ben turkia

  emergency department regional hospital of Ben Arous

  https://orcid.org/0000-0002-3364-3067 (unauthenticated)

• Firas chabaane

  emergency departement of regional hospital of Ben Arous

• Syrine Keskes

  emergency departement of regional hospital of Ben Arous

• Ines Chermiti

  emergency departement of abderrahmen Mami hospital

• Rahma Dhokkar

  emergency departement of regional hospital of Ben Arous

• Yosra Majdoub

  emergency departement of regional hospital of Ben Arous

• hanene ghazali

  emergency departement of regional hospital of Ben Arous

• Sami Souissi

  emergency departement of regional hospital of Ben Arous

The use of fibrinolytic therapy for ST segment elevation myocardial infarction (STEMI) can lead to fatal complications. The streptokinase, a non-specific fibrinolytic, remains used in developing countries. The safety of this fibrinolytic agent is under studied in the elderly population.

AIM: Compare the prognosis of elderly patients (> 75 years old) treated with Streptokinase for STEMI versus 75 years old regard to hemorrhagic complications and mortality.

Methods:

Prospective study (2009-2018). Inclusion of patients treated with Streptokinase for STEMI. Comparison of two groups: elderly patients and less than 75 years old patients.

Results:

Inclusive of 624 patients. Mean age=59±11 years. Sex-ratio=5.

Patients aged more than 75 years represented 10% of the study. The comparative study of elderly group (n=63) versus (vs) patients less than 75 years (n=561) found that elderly patients were more frequently male Sex-ratio = 1 vs 7 (p<0,001) and have more hypertension (59%) vs (25%) (p<0,001). Atypical clinical presentation was more frequent in the elderly group 30% vs 16%.  No difference was found in the two groups concerning fibrinolysis success 57% vs 61% and intracranial hemorrhage 0 vs 2 patients. In hospital and one-week mortality were higher in the elderly group with respectively, 4.8% and 8% vs 0.7% and 1.2%.Factors associated with mortality among elderly patients were:

Anterior myocardial infarction (OR=6.37, p=0.044, 95%IC 1.19-34) and cardiogenic shock (OR=38, p<0.001, 95%IC 5.02-287.43).

Streptokinase is an effective therapeutic alternative for elderly with STEMI. It causes reperfusion in 57% of cases with no significant increase of major hemorrhagic events

1. Firas chabaane, emergency departement of regional hospital of Ben Arous

   emergency doctor

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