Management and Outcome of Acute Myocardial Infarction in Older Patients in the Thrombolytic Era

Abstract

Patients more than age 75 comprise almost one-third of patients with AMI and have a poor prognosis. Although age is an independent predictor of mortality following AMI, suboptimal management may contribute to the high mortality in these patients.

Treatment and short-term outcome in women and men with acute coronary syndromes

“…In the year 2000, the benefit of thrombolysis was questioned by Thiemann et al, who even suggested a survival disadvantage in elderly patients [12]. Thoughts along this line might explain why many older patients with ST-segment elevation ACS worldwide remain untreated [11,26]. Our figures indicate that this was also the case among our patients, although PCI rather than thrombolysis was underused in comparison with the younger age groups, among both women and men.…”

“…Greater comorbidity might explain the less frequent use of invasive procedures in elderly patients. A number of reports have demonstrated that older patients with an acute MI often have a more complicated hospital course than younger ones [11]. In our study, the occurrence of re-infarction, heart failure and atrial fibrillation increased with age, as did the use of inotropic drugs, anti-arrhythmics and diuretics.…”

“…Previous experience shows that mortality, morbidity and the use of medical resources differ not only according to gender but also between various age groups [11,13,14]. Women and the elderly are under-represented in trials [15].…”

“…Women are affected by ACS at a higher age than men and the question whether the elderly receive and benefit from recommended therapy is another unresolved issue which is of particular interest from a gender perspective [7,11,12]. Previous experience shows that mortality, morbidity and the use of medical resources differ not only according to gender but also between various age groups [11,13,14].…”

Pharmacological Therapy for Myocardial Infarction in the Elderly: An 8-year Analysis

“…Age is an independent predictor of mortality after acute myocardial infarction, which makes the elderly patients a high-risk group for complications and mortality 24,25 . Therefore, they have the highest potential for therapeutic benefit resulting from the use of medication that has been proved to reduce mortality after acute myocardial infarction, such as beta-blockers, acetylsalicylic acid, and angiotensin-converting enzyme inhibitors.…”