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One-Year Follow-up of a Large Prospective Cohort

Ulf Stenestrand, MD; Lars Wallentin, MD, PhD; for the Register of Information and Knowledge About Swedish Heart Intensive Care Admissions (RIKS-HIA)

Arch Intern Med. 2003;163:965-971.

Background  Fibrinolytic therapy reportedly may not be beneficial in acute ST-segment–elevation myocardial infarction (STEMI) in patients who are 75 years and older.

Methods  The association between fibrinolytic therapy and 1-year mortality and bleeding complications in an unselected large cohort of patients with STEMI was evaluated by means of propensity and Cox regression analysis adjusting for multiple factors known to influence fibrinolytic therapy as well as survival. The Register of Information and Knowledge About Swedish Heart Intensive Care Admissions recorded every patient admitted to a coronary care unit in 64 hospitals during 1995 through 1999. One-year mortality was obtained by merging with the National Cause of Death Register.

Results  A total of 6891 patients 75 years and older with first registry-recorded STEMI were included, of whom 3897 received fibrinolytic therapy and 2994 received no such treatment. Fibrinolytic therapy was associated with a 13% adjusted relative reduction in the composite of mortality and cerebral bleeding complications after 1 year (95% confidence interval, 0.80-0.94; P = .001). This effect seemed homogeneous among all subgroups based on age, sex, coronary risk factors, and previous disease manifestations.

Conclusions  Fibrinolytic therapy in patients with STEMI who are 75 years and older is associated with a reduction in the composite of mortality and cerebral bleedings after 1 year. These results from an unselected coronary care unit population support the use of fibrinolytic therapy in elderly patients.

From the Department of Cardiology, University Hospital of Linköping, Linköping, Sweden (Dr Stenestrand); and Department of Cardiology, University Hospital of Uppsala, Uppsala, Sweden (Dr Wallentin). The authors have no relevant financial interest in this article.

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