E. Taneva

Thrombolytic therapy (TT) is applied in patients with Acute Myocardial Infarction (AMI) with ST-segment elevation, but there is an age limitation - not more 75 years old. It is recommended PTCA or by-pass surgery to elderly patients. For PTCA and by-pass surgery there has to be a prepared cardio-surgery medical team, which can be find in big medical hospitals. Patients with AMI with ST-segment elevation over 75 years, which has no TT applied, are with suspicious prognosis for longevity and quality of life.

The aim of this study is to propose recommendations and behaviour for reperfusion with TT of the coronary arteries of elderly patients.

Materials and methods: The investigation is made for a period of 5 years (2000-2004). 2462 patients are registered, from them 502 patients has AMI, and from them 103 (54 men, 49 women) are over 75 years. Rapilysin (Roche) is applied to 10 patients. General and mental state of patients and co-morbidity are assessed. H2-blocker (Quamatel - Gedeon Richter) is used to prevent bleeding from gastro-intestinal tract.

Results: The applied TT has positive effect to these 10 patients over 75 years. The oldest woman is 89 years old and the oldest man is 93. There have been no complications during treatment in elderly patients.

Conclusion: Ageing, related to serious health problems, can be improved with application of TT to elderly patients with AMI with ST-segment elevation as an excellent reperfusion therapy. It is possible a dose reduction of the thrombolytic agent, arterial pressure not higher than 160/100 mm/Hg, individual risk assessment for intracranial haemorrhage and prevention of bleeding from gastro-intestinal tract.

Keywords (Optional): 
acute myocardial infarction
thrombolytic therapy