Is Primary Angioplasty the Best Treatment for AMI in the Elderly?
The elderly, particularly those over 80, are the fastest growing component of the population. Coronary artery disease accounts for 44% of all deaths in the elderly. Age is also one of the strongest predictors of mortality from acute myocardial infarction (AMI) and in those that survive, long term outcome is worse. In part, the poor inhospital mortality is due to difficulty in diagnosis, but is also likely to be caused by the widespread reluctance to use reperfusion therapy to treat the elderly. Reperfusion therapy has been shown to be equally effective in the elderly, despite an overall increased mortality. The results of randomized trials comparing thrombolysis to angioplasty show an advantage of primary angioplasty over thrombolysis. In the Global Use of Strategies to Open Occluded coronary Arteries in Acute Coronary Syndromes (GUSTO) IIb trial, the advantage was noted in all age groups, including the elderly. The Primary Angioplasty in Myocardial Infarction (PAMI) trial supports these findings. The trials also suggest that the risks are lower with angioplasty than thrombolysis, with a significant lower risk of stroke. Today, with improved outcomes using stents and glycoprotein IIb/IIIa agents, the advantages of primary angioplasty may be even greater than those reported in prior trials. The available data strongly support the use of primary angioplasty in the elderly as an effective reperfusion therapy and, due to improved safety and greater efficacy, should be the preferred treatment in the elderly. (c)1999 by CVRR, Inc.
Mehra
Anil
A
Cardiac Catheterization Laboratory, University of Southern California School of Medicine, LAC+USC Medical Center, Los Angeles, CA.
Faxon
David P.
DP