European Heart Journal Advance Access originally published online on April 26, 2005
European Heart Journal 2005 26(17):1705-1711; doi:10.1093/eurheartj/ehi284
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Effect of thrombolytic therapy on the risk of cardiac rupture and mortality in older patients with first acute myocardial infarction
Department of Cardiology, Hospital General Universitario ‘Gregorio Marañón’ Dr Esquerdo, 46, 28007 Madrid, Spain
Received 11 July 2004; revised 4 March 2005; accepted 24 March 2005; online publish-ahead-of-print 26 April 2005.
* Corresponding author. Tel: +34 91 5868276; fax: +34 91 5868276. E-mail address: hecbueno{at}jet.es
See page 1693 for the editorial comment on this article (doi:10.1093/eurheartj/ehi353)
Aims To evaluate the effect of thrombolysis on mortality and its causes in older patients with acute myocardial infarction (AMI).
Methods and results An analysis of 706 consecutive patients 
75 years old with a first AMI enrolled in the PPRIMM75 registry showed that although there were important differences in baseline characteristics among patients treated with thrombolysis, primary angioplasty (PA) and those who did not receive reperfusion therapy, 30 day mortality did not differ (29, 25, and 32%, respectively). The main cause of death in patients treated with thrombolysis was cardiac rupture (54%), whereas most of the other patients died in cardiogenic shock. Patients who received thrombolysis had a higher (P<0.0001) incidence of free wall rupture (FWR) (17.1%) compared with those who did not receive reperfusion therapy (7.9%) or who underwent PA (4.9%). By multivariable analysis, patients treated with thrombolytic therapy (TT) showed an excess risk of FWR (OR, 3.62; 95% CI, 1.79–7.33), a hazard not observed in patients who underwent PA. When compared with patients who did not receive reperfusion therapy, the odds ratio of 30 day mortality was 1.07 (95% CI, 0.65–1.76) for patients treated with thrombolysis and 0.78 (95% CI, 0.45–1.34) for those who underwent PA. The figures for 24 month mortality were 0.78 (95% CI, 0.65–1.76) and 0.67 (95% CI, 0.28–0.81), respectively.
Conclusion Treatment of first AMI with TT increases the risk of FWR in very old patients, a risk not observed in patients treated with PA.
Key Words: Myocardial infarction • Cardiac rupture • Elderly • Thrombolysis • Primary angioplasty
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