Poor outcomes after fibrinolytic therapy for ST-segment elevation myocardial infarction: impact of age (a meta-analysis of a decade of trials).

Journal of Thrombosis and Thrombolysis
Shaheeda AhmedEugene Braunwald

Abstract

Fibrinolysis for ST-segment elevation myocardial infarction (STEMI) reduces mortality, but its relative efficacy and risks are age-dependent. We aimed to quantify the outcomes of fibrinolysis and adjunctive antithrombin therapy for STEMI stratified by age. We performed a meta-analysis of 11 published (1992-2001) randomized clinical trials of fibrinolysis in STEMI (sample size >or=3,000, no age limit, no placebo-controlled arms) identified by MEDLINE through June 2005. Event rates and odds ratios (OR) in elderly vs. younger patients were calculated for mortality, intracranial hemorrhage (ICH) and total stroke (CVA). Elderly patients were defined as >or=75 years (GUSTO I, TIMI 9B, GUSTO III, COBALT, ASSENT-2, InTIME-II TIMI-17, ASSENT-3, GUSTO V, and HERO-2), except when defined as >65 or >or=70 years by the study (INJECT and ISIS-3). Elderly (n = 24,531) vs. younger (n = 123,568) patients had increased rates of mortality (19.7% vs. 5.5%), ICH (1.4% vs. 0.5%) and CVA (3.5 vs. 1.2%) by 30-35 days; the excess risk for these events was substantial (OR mortality 4.37, 95% CI 4.16-4.58; ICH 2.83, 2.47-3.24; CVA 2.92, 2.62-3.25; p < 0.001 for all). Despite established mortality reductions with fibrinolysis for STEMI, elderly compared w...Continue Reading

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Jan 5, 2007·The New England Journal of Medicine·Ellen C Keeley, L David Hillis
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Jul 27, 2014·International Journal of Cardiology·Emil Binsell-GerdinThomas Mooe
Feb 22, 2017·Journal of Thrombosis and Thrombolysis·Leonard L L YeoVijay K Sharma

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