ELIGIBILITY OF ELDERLY PATIENTS WITH SUSPECTED MYOCARDIAL-INFARCTION FOR TREATMENT WITH STREPTOKINASE

Background: The benefit of streptokinase in patients with acute myocardial infarction is potentially greatest in the old, yet increasing age is also an independent predictor that a patient will not receive thrombolytic therapy. This prospective observational study investigated possible factors influencing use of streptokinase in patients aged 65 years or more who were hospitalized with suspected acute myocardial infarction. Methods: Information about delay in admission, diagnostic difficulties, and possible contraindications to thrombolysis was collected from all eligible patients admitted to two general hospitals during a 6-month period. Results: Two hundred fifty-one patients were studied, 178 (71%) of whom were aged 75 years or more. Twenty-eight (11%) patients received streptokinase, and in 26 of these myocardial infarction was subsequently confirmed. Another 83 patients with confirmed myocardial infarction did not receive thrombolysis. The major reasons for ineligibility for streptokinase were a nondiagnostic ECG in 183 (73%) patients, absence of typical chest pain in 134 (53%), and time of onset of symptoms unobtainable in 69 (27%). The median delay before hospital admission in those able to give this information was 185 minutes (range, 10 minutes to 22 hours). Absolute contraindications to thrombolysis were present in only nine (4%) cases, including active internal bleeding in four (2%), severe hypertension in three (2%), and aortic aneurysm in two (1%). Conclusions: Elderly patients with suspected myocardial infarction do not receive thrombolysis because of problems in obtaining an accurate history and interpreting the ECG rather than presence of absolute medical contraindications or delays before hospital admission. Improved methods of early diagnosis are required if the proportion of elderly patients receiving thrombolysis is to be increased.