Reperfusion therapy for acute myocardial infarction in elderly patients

Abstract

Although there has been great progress in reperfusion therapy, the role of coronary reperfusion for elderly patients with acute myocardial infarction has not been fully investigated. In general, mean age of the subjects in major trials was about 60 years old and approximately only 10 to 15% of patients were over age 75. On the other hand, large-scale registries such as the US national registry of myocardial infarction (NRMI) showed a higher prevalence of elderly (especially women) in the clinical setting. This discrepancy may be due to the fact that elderly patients with myocardial infarction have some difficulties in the treatment such as severe multi-vessel coronary lesions, non-cardiac complications and relatively high prevalence of adverse reactions to reperfusion therapy. Here we focus on the situation of elderly patients (especially those 75 years or older) with myocardial infarction in the "real world" clinical setting, showing the clinical changes and outcome of our registry in rural Japan: the Kochi AMI (KAMI) registry.

Quantitative Gated Single-Photon Emission Computed Tomography With 99mTc Sestamibi Predicts Major Cardiac Events in Elderly Patients With Known or Suspected Coronary Artery Disease The QGS-Prognostic Value in the Elderly (Q-PROVE) Study

“…In Japan, rates of CAD continue to increase in the elderly 14,15 and the impact on medical practice is huge. Important differences should be taken into account in elderly patients with CAD as compared with their younger counterparts: symptom presentation may be different, and complex coronary lesions, coexisting illness, and functional limitations are more prevalent, and the risk of revascularization procedures is generally increased.…”

Exercise training combined with alprostadil improves myocardial infarction and coronary microcirculation disorder in aged rats by inhibiting mitogen-activated protein kinase (MAPK) signaling pathway activation

“…Myocardial injuries that occur at reperfusion include arrhythmias, transient mechanical dysfunction of the heart, microvascular damage, and oxidative stress (OS) response (7). MI is mainly treated with drugs and surgery, but the prognosis remains unsatisfactory (8). A study showed that the levels of YKL-40 and sTNFR1 were associated with poor cardiac function and prognosis (9).…”