Which strategy should be used for acute ST-elevation myocardial infarction in patients aged more than 75 years?
The optimal management of acute myocardial infarction in elderly people (>or= 75 years) is controversial because elderly patients have been excluded or are under-represented in most acute myocardial infarction trials. Randomized studies show that, also in the elderly, thrombolytic therapy is effective in reducing mortality after acute myocardial infarction but the benefit in terms of mortality, recurrent infarction and stroke is smaller compared to primary percutaneous coronary intervention. Among the available mechanical therapeutic strategies, stenting is found to be superior to balloon angioplasty, whereas the role of drug-eluting stents in this setting still remains to be evaluated. The standard use of intravenous unfractionated heparin is still recommended because of the increased risk of intracranial haemorrhage by a combination of low molecular weight heparin or IIb/IIIa inhibitors and thrombolytic agents. Dedicated randomized clinical trials are needed to establish the best reperfusion therapy for this expanding population, especially in patients admitted to hospitals without percutaneous coronary intervention facilities and in patients developing cardiogenic shock.
La Manna
Alessio
A
Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy.
Goktekin
Omer
O
Fiscella
Damiana
D
Dalby
Miles
M
Tanigawa
Jun
J
Fiscella
Antonio
A
Tamburino
Corrado
C
Di Mario
Carlo
C
D000368:Aged; D017130:Angioplasty / Q000379:methods; D000925:Anticoagulants / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy*; D010360:Patient Transfer; D015607:Stents; D015912:Thrombolytic Therapy
D000925:Anticoagulants; D005343:Fibrinolytic Agents