Early management of acute myocardial infarction in the elderly

Abstract

The efficacy of reperfusion treatment has been established in patients with acute myocardial infarction (AMI), however, its role is still controversial in the elderly patients. Data from Kochi Acute Myocardial Infarction Registry, consisting of 1,248 cases, showed that, compared to younger patients, elderly patients had greater ratio of women, painless infarction, delayed presentation, worse Killip classes, lower reperfusion procedure and higher mortality. To clarify the early management of AMI in the elderly, we analyzed the clinical data of 1,160 cases, according to age subgroup (317 advanced elderly, aged 75-84; 438 elderly, aged 65-74; 405 middle-aged, aged 45-64) and according to the period (term I, 1990-92; term II, 1993-95; term III, 1996-98). RESULTS: 1) The advanced elderly received less reperfusion treatment (37% vs. 65%) and showed higher mortality (21% vs. 8%), compared to middle-aged patients. 2) In advanced elderly patients, mortality was reduced (term I, 27%; term II, 20%; term III, 19%), according to increasing application of reperfusion treatment (term I, 22%; term II, 45%; term III, 40%). 3) Inoadvanced elderly patients with reperfusion treatment, thrombolysis resulted in a higher mortality (17% vs. 7%) compared to direct angioplasty, probably due to increased incidence of cardiac rupture and pump failure in this age group. CONCLUSIONS: Reperfusion treatment improves mortality of AMI even in elderly patients. To minimize complications, direct angioplasty may be better for elderly patients.