Temporal trends, characteristics and outcomes of fibrinolytic therapy for ST-elevation myocardial infarction among patients 80 years or older

Catheter Cardiovasc Interv. 2018 Dec 1;92(7):E425-E432. doi: 10.1002/ccd.27833. Epub 2018 Sep 30.


Background: Pharmacologic reperfusion therapy is a recommended and effective strategy in patients with ST-elevation myocardial infarction (STEMI) when percutaneous coronary intervention (PCI) is not available. This study investigates temporal trends and outcomes of fibrinolytic therapy (FT) in elderly patients with STEMI.

Methods: Using the Nationwide Inpatient Sample database, we extracted patients ≥80 years a primary diagnosis of STEMI admitted between 2010 and 2014. Using ICD codes, we identified patients who underwent FT. We performed temporal trend analysis, then compared characteristics and inpatient outcomes in the FT group versus no-FT group. Our primary outcome of interest was hemorrhagic stroke (HS). We also assessed the impact of HS on mortality and discharge to skilled nursing facility (SNF).

Results: Of the 917,307 patients with STEMI, 16.1% (n = 147,874) were aged 80 or older. Primary PCI was performed in 46.2%, 2.4% underwent FT, and 51.3% had neither pharmacologic nor mechanical revascularization. The rate of FT increased (1.9%-2.4%) in a nonlinear trend over the five years of the study. The FT group was eight times more likely to suffer HS (P < 0.001). FT was an independent predictor of HS (OR 7.90, 95% CI 4.36-14.30; P < 0.001), whether they underwent PCI or not. HS was an independent predictor of mortality and SNF discharge.

Conclusion: FT in patients 80 years or older presenting with STEMI was associated with an eight-fold increase in HS and no associated mortality advantage, both with or without PCI. These data underscore the increased risk of FT in the elderly.

Keywords: ST-elevation myocardial infarction; elderly; fibrinolysis; hemorrhagic stroke.

MeSH terms

  • Age Factors
  • Aged, 80 and over
  • Databases, Factual
  • Female
  • Humans
  • Incidence
  • Inpatients
  • Intracranial Hemorrhages / epidemiology
  • Male
  • Patient Discharge / trends
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • ST Elevation Myocardial Infarction / drug therapy*
  • ST Elevation Myocardial Infarction / mortality
  • Skilled Nursing Facilities / trends
  • Stroke / epidemiology
  • Thrombolytic Therapy / adverse effects
  • Thrombolytic Therapy / mortality
  • Thrombolytic Therapy / trends*
  • Time Factors
  • Treatment Outcome
  • United States / epidemiology