Age Related Issues in Reperfusion of Myocardial Infarction

Abstract

Advances in pharmacological treatment and effective early myocardial revascularization have led to improved clinical outcomes in patients with acute myocardial infarction (AMI). However, it has been suggested that compared to younger subjects, elderly AMI patients are less likely to receive evidence-based treatment. Several reasons have been postulated to explain this trend, including uncertainty regarding the benefits of the commonly used interventions in the older age group as well as increased risk associated with comorbidities. The diagnosis, management, and post-hospitalization care of elderly patients presenting with an acute coronary syndrome (ACS) pose many difficulties at present due, at least in part, to the fact that trial data are scanty as elderly patients have been poorly represented in most clinical trials. Thus it appears that these high-risk individuals are often managed with more conservative strategies, compared to younger patients. This article reviews current evidence regarding management of AMI in the elderly.

Effect of ATP-dependent channel modulators on ischemia-induced arrhythmia change depending on age and gender

“…1,3,24 Clinically, death following acute myocardial infarction was shown to be more likely in human beings of older age than in young people. 25,26 It was also shown that death due to acute myocardial infarction was encountered more often in males compared to corresponding females before menopause, and was the same after menopause. 27 Drugs such as antihistamines, antibiotics, antimalarials and anti arrhythmic induce the torsades de pointes type of ventricular arrhythmia much more easily in females rather than males.…”

Impact of comorbidities and gender on the use of coronary interventions in patients with high‐risk non‐ST‐segment elevation acute coronary syndrome

“…Increasing age has been shown to reduce the use of invasive therapies for ACS, despite the fact that these offer survival benefit at all ages . It is important that comorbidities are taken into account when determining a course of treatment for elderly patients because they may influence vulnerability to adverse drug reactions . There is also an ethical question underlying the decision to intervene (which considers patient choice and beneficence) and it has been acknowledged that physicians may be reluctant to apply therapies to patients with advanced noncardiac comorbidities on the principle of “primum nil nocere” .…”

Prognostic value of troponins in acute coronary syndrome depends upon patient age

“…Due to uncertainties around the benefits of the invasive interventions, despite their higher risk of adverse clinical outcomes following ACS, older patients may often be managed with more conservative strategies compared with younger patients 19. Although there is evidence to suggest that adherence to guideline-recommended therapy is associated with a decrease in mortality,20 the management of ACS in older age is challenging.…”