Summary
The age of patients suffered from ST-elevation myocardial infarction (STEMI) is expected to rise in the next decades. In elderly patients, the outcome after STEMI is worse than in younger people, but they are less likely to receive reperfusion therapies (Madhavan et al., 2018).
So, this study aimed at assessing the effect of management strategy of ST segment elevation myocardial infarction in elderly on LV remodeling and clinical outcome.
This study included 150 elderly patients older than 60 years with ST segment elevation myocardial infarction referred to the Coronary care unit, Benha University Hospital and classified into 3 groups according to management strategy:
- Group I: patients who treated with conservative therapy.
- Group II: patients who treated with primary percutaneous intervention.
- Group III: patients who treated with fibrinolytic therapy.
• The current study concluded that patients of group I were significantly older than those of group II and group III (p ˂ 0.001).
• Smoking was significantly prevalent in patients of group III than those of group I and II (p ˂ 0.001).
• There was no statistical difference between patients of 3 groups regarding EF, LVESV, LVEDV and SD of time to reach minimum systolic volume (p˃0.05).
• Follow up echocardiography was done after 3 months, the study included 144 patients (6 patients died during follow up), patients were classified according to the presence of LV remodeling into 2 groups:
- Group A: patients with LV remodeling (43 patients “30 %”).
- Group B: patients without LV remodeling (101 patients “70 %”).
• Male gender was more prevalent in the non remodeling (p= 0.014).
• DM, HTN, smoking, dyslipidemia and family history of CAD were more prevalent in patients of group A.
• Patients with conservative therapy (group I) and PCI (group II) were more prevalent in group B patients, while patients with fibrinolytic therapy were more prevalent in group A patients.
• LVESV and LVEDV were higher in group A patients. Moreover, GLS and LVEF were lower among patients of group A (p˂0.001).
• Regarding in hospital complications, heart failure, cardiogenic shock, bleeding, reinfarction and stroke were more prevalent in group A.
• Regarding 3 months complications, heart failure, cardiogenic shock, reinfarction and arrhythmia were more prevalent in group A patients.
• In multivariate regression analysis using the forward stepwise method, streptokinase therapy is the most predictor for remodeling in relation to PCI and conservative therapy.
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