Reperfusion therapy in elderly patients with acute myocardial infarction: a randomized comparison of primary angioplasty and thrombolytic therapy

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. The benefit of reperfusion therapy in elderly patients with AMI is uncertain, although elderly people...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2002-06, Vol.39 (11), p.1723-1728
Main Authors: de Boer, Menko-Jan, Ottervanger, Jan-Paul, van 't Hof, Arnoud W J, Hoorntje, Jan C A, Suryapranata, Harry, Zijlstra, Felix
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Angioplasty
Angioplasty, Balloon, Coronary
Cardiology
Coronary vessels
Drug Therapy, Combination
Female
Fibrinolytic Agents - therapeutic use
Heart attacks
Humans
Infusions, Intravenous
Male
Mortality
Myocardial Infarction - complications
Myocardial Infarction - drug therapy
Myocardial Infarction - mortality
Myocardial Infarction - therapy
Stents
Streptokinase - therapeutic use
Stroke - etiology
Survival Analysis
Thrombolytic Therapy
Treatment Outcome
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Summary: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. The benefit of reperfusion therapy in elderly patients with AMI is uncertain, although elderly people account for a large proportion of deaths. 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. 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). 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.
ISSN:0735-1097
1558-3597
DOI:10.1016/S0735-1097(02)01878-8