Therapy for acute myocardial infarction in older persons.
OBJECTIVE
To review the early management of acute myocardial infarction (AMI) in older adults.


METHODS
Recently published studies relevant to the early management of AMI were systematically reviewed. When possible, the impact of older age on complication rates and clinical outcomes was evaluated.


RESULTS
In general, AMI therapies that are effective in younger patients are also effective in older patients. Conversely, older age is associated with an increased risk of complications from therapy, implying that careful patient selection is required to optimize outcomes while minimizing risks. The principal limitation of currently available data is that relatively few patients older than the age of 80 have been enrolled in prospective randomized clinical trials.


CONCLUSIONS
Thrombolysis and primary angioplasty are effective in establishing reperfusion and improving clinical outcomes in older patients with AMI. In the absence of contraindications, aspirin and beta blockers should be considered standard therapy in AMI patients of all ages, whereas heparin, nitrates, and angiotensin converting enzyme inhibitors are indicated in selected subgroups. At the present time, calcium channel blockers, magnesium, and antiarrhythmic agents are not recommended for routine use in the AMI setting, and the role of glycoprotein IIb/IIIa inhibitors, low molecular weight heparin, and other newer agents await the results of ongoing clinical trials.
Director, Geriatric Cardiology Program, Washington University School of Medicine, St. Louis, Missouri, USA.
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D000367:Age Factors; D000368:Aged; D017130:Angioplasty; D015906:Angioplasty, Balloon, Coronary; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use; D005853:Geriatrics; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion
D005343:Fibrinolytic Agents