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Objective: Ischemic heart disease is the leading cause of mortality in population above the age of 70 years. ST-elevation myocardial infarction (STEMI) constitutes important treatable cause of death in elderly population. However, many large, randomized trials have excluded this age group. The present study was planned to find out the benefits and complications related to thrombolytic therapy in elderly patients. Materials and Methods: The study was done between January 1, 2019, and December 31, 2019, in the Department of Cardiology, Sri Jayadeva Institute Of Cardiovascular Sciences and Research, Bengaluru, India, which included the study group comprising 106 elderly patients (age >70 years) with acute STEMI and underwent thrombolytic therapy. All patients were followed up till the index hospitalization and evaluated for in-hospital outcome. Results: Out of the 106 patients in the study group, 64 (60.38%) were male and 42 (39.62%) were female. Out of which, 88 (83%) patients were between 70 and 80 years whereas 18 (17%) patients were >80 years. Mortality was happened in 32 patients (30.2%). Coronary angiogram post thrombolysis was performed as pharmacoinvasive or rescue percutaneous coronary intervention (PCI) in 25 patients (23.6%), and cardiac arrhythmias were noted in 22 (20.6%) patients, acute kidney injury in 7 (6.6%) patients, ventricular septal rupture in 5.7%, ischemic stroke in 4.7%, free-wall rupture in 2.8%, and intracranial hemorrhage in 0.9% of patients. Conclusions: Primary PCI may offer clinical advantage over fibrinolytic therapy as manifested by the trends toward improvements in the combined endpoint of death, reinfarction, and stroke in the oldest patients. Despite the higher prevalence of comorbidities and high-risk features in elderly patients of acute STEMI, timely thrombolysis is also beneficial particularly who present early after symptom onset, absence of comorbid condition, and lower NYHA class on admission (NYHA I/II). In developing countries like India where primary PCI may not be feasible, timely thrombolysis should be given to the elderly patients also.

Background: Cerebrovascular events (CVEs) are one of the rare complications of cardiac catheterization. This prospective single-center study was conducted to assess the incidence, presentations, and outcomes of CVEs in patients undergoing cardiac catheterization. Methods: Patients undergoing cardiac catheterization who developed CVEs within 48 h of procedure were analyzed prospectively with clinical assessment and neuroimaging. Results: Out of 55,664 patients, 35 had periprocedural CVEs (0.063%). The incidence of periprocedural CVEs with balloon mitral valvotomy, percutaneous coronary intervention, and coronary angiography was 0.127%, 0.112%, and 0.043%, respectively. A larger proportion of periprocedural CVEs occurred in patients with acute coronary syndrome (ACS, 77.1%) than in patients with stable coronary artery disease (CAD). The majority of CVEs were ischemic type (33 patients, 94.3%). It was most commonly seen in the left middle cerebral artery (MCA) territory. Hemorrhagic CVEs were very rare (2 patients, 5.7%). The majority of the CVEs manifested during or within 24 h of the procedure (31 patients, 88.6%). Neurodeficits persisted during the hospital stay in 20 patients (57.2%), who had longer duration of procedure compared to those with recovered deficits ( P = 0.0125). In-hospital mortality occurred in three patients (8.5%) and post-discharge mortality in another 3 (8.5%). Conclusions: Periprocedural CVEs are rare and have decreased over time. They occur in a greater proportion in patients with ACS than in patients with stable CAD, more with interventional than diagnostic procedures. Ischemic event in the left MCA territory is the most common manifestation, commonly seen within 24 h of the procedure. Longer duration of procedure was a risk factor for larger infarcts and hence persistent neurodeficit at discharge. Although a substantial number of patients recover the neurodeficits, periprocedural CVEs are associated with adverse outcomes.