Primary percutaneous coronary intervention vs. fibrinolytic therapy for acute ST-elevation myocardial infarction in the elderly.
Advanced age is associated with worse prognosis among patients with acute ST-elevation myocardial infarction. Many eligible elderly patients with acute ST-elevation myocardial infarction, however, do not receive any reperfusion therapy at all. The risk of intracranial hemorrhage complicating fibrinolytic therapy increases with age. Furthermore, routine adjunctive stenting has made coronary angioplasty safer. In total, primary percutaneous coronary intervention is the preferred reperfusion strategy among elderly patients with acute ST-elevation myocardial infarction, provided that it can be performed without excessive delay. The break-even incremental delay with primary percutaneous coronary intervention compared with fibrinolytic therapy is not clear at this point and will need to be elucidated by future investigation.
Karha
Juhana
J
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. topole@ccf.org.
Topol
Eric J
EJ
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D015912:Thrombolytic Therapy
D000925:Anticoagulants; D005343:Fibrinolytic Agents