Clinical investigationsPrimary angioplasty with routine stenting compared with thrombolytic therapy in elderly patients with acute myocardial infarction
Section snippets
Patient population
This study is a prospective analysis of 130 consecutive patients ≥70 years of age from the greater Tel-Aviv area with ST-elevation AMI. Patients were admitted to the intensive coronary care units (ICCUs) of 2 local medical centers (Soraski Medical Center and Sheba Medical Center, both affiliated with the Tel Aviv University Sackler School of Medicine) between February 1998 and November 1999. Each patient entered the emergency department of the medical center in the vicinity, with similar
Results
Of the 130 patients who comprised the study population, 86 (66%) were admitted to center I and 44 (34%) were admitted to center II. Of the 86 patients who were treated with thrombolytic therapy, 41 (48%) were catheterized during hospitalization because of unsuccessful thrombolysis requiring rescue angioplasty (n = 4), recurrent spontaneous ischemia (n = 30), positive stress test results (n = 6), and after a diagnosis of a ventricular septal defect (n = 1). Coronary angioplasty was performed in
Discussion
Although elderly patients, who comprise as much as 80% of all patients with AMI, have a substantially worse short- and long-term prognosis, acute treatment is usually less vigorous in older patients than younger patients.5 Thrombolytic therapy is often withheld from elderly patients because of the fear of bleeding complications, particularly intracerebral hemorrhage, and the contradictory data on the efficacy of this therapy in the older age group.2, 3, 4, 5, 15, 16, 17, 18, 19, 20 Thus, safer
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Cited by (66)
Management and Care of Older Cardiac Patients
2017, Encyclopedia of Cardiovascular Research and MedicineField triage to primary percutaneous coronary intervention: Factors influencing health-related quality of life for patients aged ≥70 and <70 years with non-complicated ST-elevation myocardial infarction
2016, Heart and Lung: Journal of Acute and Critical CareCitation Excerpt :Historically, older patients were excluded from PCI clinical trials11 due to frailty, poor coronary vasculature and multiple comorbidities which predisposed them to increased major adverse cardiovascular events (MACE) such as strokes or death. Despite these limitations, older individuals appear to benefit from PCI.12,13 The Senior PAMI trial for example, demonstrated that STEMI patients aged ≥70 years treated with PCI had significantly reduced incidences of death, strokes and AMI.14
Difficult Subsets for Percutaneous Coronary Interventions: Calcific Vessels, Coronary Bypass Conduits, Elderly Patients, and Cardiac Transplantation
2012, The Interventional Cardiac Catheterization Handbook, Third EditionImpact of age on treatment and outcomes in ST-elevation myocardial infarction
2011, American Heart JournalCitation Excerpt :Numerous randomized clinical trials have compared a strategy of PCI to fibrinolysis for patients with STEMI, but older patients have been excluded from most of these trials.9 Three relatively small randomized clinical trials appear to support PCI over fibrinolysis, but the results are inconclusive.16-18 Observational registries also suggest a benefit of PCI over fibrinolysis in older STEMI patients.19-21,25
The aging heart and post-infarction left ventricular remodeling
2011, Journal of the American College of CardiologyCitation Excerpt :All patients with ST-segment elevation MI should undergo rapid evaluation for reperfusion therapy and have a reperfusion strategy implemented promptly after contact with the medical system (Level of Evidence: A). Elderly patients appear to have a modest benefit from PCI over fibrinolysis, although the benefit is mainly in recurrent ischemia (17,83). This suggests that suitable elderly patients can be offered primary PCI and may benefit from this approach.