Reperfusion therapy in elderly patients with acute myocardial infarction: a randomized comparison of primary angioplasty and thrombolytic therapy.
OBJECTIVE
This study sought to determine the short- and long-term outcome of primary coronary angioplasty and thrombolytic therapy for acute myocardial infarction (AMI) in patients older than 75 years of age.


BACKGROUND
The benefit of reperfusion therapy in elderly patients with AMI is uncertain, although elderly people account for a large proportion of deaths.


METHODS
We randomly assigned a total of 87 patients with an AMI who were older than 75 years to treatment with angioplasty or intravenous (IV) streptokinase. Clinical outcome was measured by taking the end points of death and the combination of death, reinfarction or stroke during follow-up.


RESULTS
The primary end point, a composite of death, reinfarction or stroke, at 30 days had occurred in 4 (9%) patients in the angioplasty group as compared with 12 (29%) in the thrombolysis group (p = 0.01, relative risk [RR]: 4.3, 95% confidence interval [CI]: 1.2 to 20.0). At one year the corresponding figures were 6 (13%) and 18 (44%), respectively (p = 0.001, RR: 5.2, 95% CI: 1.7 to 18.1).


CONCLUSIONS
In this series of patients with AMI who were older than 75 years, primary coronary angioplasty had a significant clinical benefit when compared with IV streptokinase therapy.
de Boer
Menko-Jan
MJ
Department of Cardiology, Isala Klinieken lokatie de Weezenlanden, Groot Wezenland 20, 8011 JW Zwolle, the Netherlands. ereis@planet.nl
Ottervanger
Jan-Paul
JP
van 't Hof
Arnoud W J
AW
Hoorntje
Jan C A
JC
Suryapranata
Harry
H
Zijlstra
Felix
F
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D015607:Stents; D013300:Streptokinase / Q000627:therapeutic use*; D020521:Stroke / Q000209:etiology; D016019:Survival Analysis; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D013300:Streptokinase