Thrombolytic Therapy is Indicated for Patients Over 75 Years
From the available data, one cannot conclude whether thrombolytic therapy is beneficial or detrimental in patients older than age 75 years with acute myocardial infarction. Data favor the use of primary percutaneous transluminal coronary angioplasty rather than thrombolysis in eligible patients older than age 75 years with acute myocardial infarction to reduce mortality, recurrent myocardial infarction, stroke, and intracranial hemorrhage. High-risk elderly patients with acute myocardial infarction, such as those with a large anterior myocardial infarction complicated by heart failure and hypotension, those with persistent ischemic pain or marked ST-segment changes, those with hemodynamic instability, and those at high risk for stroke or bleeding complications, should, especially, be treated with percutaneous transluminal coronary angioplasty.
Patients older than age 75 years comprise 36% of all patients with acute myocardial infarction (MI) and 60% of all deaths from acute MI. Reperfusion therapy, including thrombolytic therapy and primary percutaneous transluminal coronary angioplasty (PTCA), is underutilized in eligible elderly patients with acute MI. This is especially true in high-risk patients -- like elderly patients with large anterior MI complicated by heart failure and hypotension -- who have the most to gain from aggressive therapy. This article reviews data on the efficacy of thrombolytic therapy vs. PTCA in the treatment of patients older than age 75 years with acute MI associated with ST-segment elevation or left bundle branch block.
From the available data, one cannot conclude whether thrombolytic therapy is beneficial or detrimental in patients older than age 75 years with acute myocardial infarction. Data favor the use of primary percutaneous transluminal coronary angioplasty rather than thrombolysis in eligible patients older than age 75 years with acute myocardial infarction to reduce mortality, recurrent myocardial infarction, stroke, and intracranial hemorrhage. High-risk elderly patients with acute myocardial infarction, such as those with a large anterior myocardial infarction complicated by heart failure and hypotension, those with persistent ischemic pain or marked ST-segment changes, those with hemodynamic instability, and those at high risk for stroke or bleeding complications, should, especially, be treated with percutaneous transluminal coronary angioplasty.
Patients older than age 75 years comprise 36% of all patients with acute myocardial infarction (MI) and 60% of all deaths from acute MI. Reperfusion therapy, including thrombolytic therapy and primary percutaneous transluminal coronary angioplasty (PTCA), is underutilized in eligible elderly patients with acute MI. This is especially true in high-risk patients -- like elderly patients with large anterior MI complicated by heart failure and hypotension -- who have the most to gain from aggressive therapy. This article reviews data on the efficacy of thrombolytic therapy vs. PTCA in the treatment of patients older than age 75 years with acute MI associated with ST-segment elevation or left bundle branch block.