A Study to Assess the Safety and Efficacy of Pharmacoinvasive Approach Young Versus Old Patients with ST Elevation Myocardial Infarction at a Tertiary Care Center

INTRODUCTION: In this study we evaluated the safety and efficacy of fibrinolytic therapy in young patients (≤40) vs old patients (>40) and the need for PCI following fibrinolysis. OBJECTIVES OF THE STUDY: To assess efficacy and safety of pharmacoinvasive approach in young vs Old patients with ST elevation myocardial infarction in the emergency department. METHODOLOGY: Prospective observational study. Data regarding basic demographic profile, risk factors, arrival in emergency department to ECG timing, window period, total ischemic time, ECG (prefibrinolysis and postfibrinolysis), coronary angiographic report and requirement of stenting were taken and analyzed. RESULTS: Our study included 243 patients (28 taken for primary PCI and 14 had contraindications to fibrinolysis). Remaining of 201 patients were included for analysis. Among 201,36 (17.9%) were young and 165(82.1%) were old. Mean age (SD) was 35.2(4.4) years and 61.02 (9.4) among young and old respectively. Young patients had less total ischemic time, median time (IQR) is around 220 (180–260) minutes and compared to 260(180–410) minutes in old cohort (p value = 0.032). Young patients had involvement of LAD (72.2%) (p value = 0.0094) and old patients had more of RCA involvement (43%) (p value = 0.004). TIMI flow was significantly better in young cohort post fibrinolysis (p value of <0.0001). Young patients required less stenting (p value < 0.0001) post fibrinolysis. During fibrinolysis,6.5% patients had ventricular tachycardia (p value=0.015). CONCLUSION: Young patients are mostly males with less total ischemic time. On angiography, mostly have anterior wall involvement, have higher TIMI flow with clean coronaries and less requirement of stenting.