|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
J Am Coll Cardiol, 2000; 36:366-374 © 2000 by the American College of Cardiology Foundation |
* Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut, USA
Qualidigm®, Middletown, Connecticut, USA
Section of Chronic Disease Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA
Manuscript received September 24, 1999; revised manuscript received January 21, 2000, accepted March 29, 2000.
Reprint requests and correspondence: Dr. Harlan M. Krumholz, Yale University School of Medicine, 333 Cedar St., P.O. Box 208025, New Haven, Connecticut 06520-8025
harlan.krumholz{at}yale.edu
OBJECTIVES
We compared outcomes following thrombolytic therapy and primary angioplasty with no reperfusion therapy in a population-based cohort of older patients presenting with acute myocardial infarction (AMI) and indications for acute reperfusion.
BACKGROUND
Evidence supporting the efficacy of acute reperfusion (thrombolytic therapy or primary angioplasty) in the elderly with suspected AMI is not as strong as it is in younger groups.
METHODS
From a national cohort of Medicare beneficiaries with AMI, we identified 37,983 patients age 65 or older who presented within 12 h of symptom onset with ST elevation or left bundle branch block. A total of 14,341 (37.8%) received thrombolytic therapy and 1,599 (4.2%) underwent primary angioplasty within 6 h of hospital arrival.
RESULTS
After adjustment for demographic, clinical, hospital and physician factors, and co-interventions, thrombolytic therapy was not associated with a better 30-day survival (odds ratio [OR] 1.01; 95% confidence interval [CI]: 0.94 to 1.09) compared with no therapy, whereas primary angioplasty was (OR 0.79; 95% CI: 0.66 to 0.94). At one year, both thrombolytic therapy (OR 0.84; 95% CI: 0.79 to 0.89) and primary angioplasty (OR 0.71; 95% CI: 0.61 to 0.83) were associated with a survival benefit.
CONCLUSIONS
In this national sample of older patients, those who received thrombolytic therapy or primary angioplasty had lower mortality at one year compared with those who did not receive a reperfusion strategy. However, only primary angioplasty was associated with better survival at 30 days. Our findings should heighten interest in further investigating the best approach to the treatment of older patients with suspected AMI and ST segment elevation or left bundle branch block.
| ||||||||||||||||||||||||||||
This article has been cited by other articles:
|
|
 |
|
  S. G. Goodman, V. Menon, C. P. Cannon, G. Steg, E. M. Ohman, and R. A. Harrington Acute ST-Segment Elevation Myocardial Infarction: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 708S - 775S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. P. Alexander, L. K. Newby, P. W. Armstrong, C. P. Cannon, W. B. Gibler, M. W. Rich, F. Van de Werf, H. D. White, W. D. Weaver, M. D. Naylor, et al. Acute Coronary Care in the Elderly, Part II: ST-Segment-Elevation Myocardial Infarction: A Scientific Statement for Healthcare Professionals From the American Heart Association Council on Clinical Cardiology: In Collaboration With the Society of Geriatric Cardiology Circulation, May 15, 2007; 115(19): 2570 - 2589. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. S. Pinto, A. J. Kirtane, B. K. Nallamothu, S. A. Murphy, D. J. Cohen, R. J. Laham, D. E. Cutlip, E. R. Bates, P. D. Frederick, D. P. Miller, et al. Hospital Delays in Reperfusion for ST-Elevation Myocardial Infarction: Implications When Selecting a Reperfusion Strategy Circulation, November 7, 2006; 114(19): 2019 - 2025. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Bueno, M. Martinez-Selles, E. Perez-David, and R. Lopez-Palop Effect of thrombolytic therapy on the risk of cardiac rupture and mortality in older patients with first acute myocardial infarction Eur. Heart J., September 1, 2005; 26(17): 1705 - 1711. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. H. Mehta, C. B. Granger, K. P. Alexander, E. Bossone, H. D. White, and M. H. Sketch Jr Reperfusion strategies for acute myocardial infarction in the elderly: Benefits and risks J. Am. Coll. Cardiol., February 15, 2005; 45(4): 471 - 478. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Guagliumi, G. W. Stone, D. A. Cox, T. Stuckey, J. E. Tcheng, M. Turco, G. Musumeci, J. J. Griffin, A. J. Lansky, R. Mehran, et al. Outcome in Elderly Patients Undergoing Primary Coronary Intervention for Acute Myocardial Infarction: Results From the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Trial Circulation, September 21, 2004; 110(12): 1598 - 1604. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Menon, R. A. Harrington, J. S. Hochman, C. P. Cannon, S. D. Goodman, R. G. Wilcox, H. J. Schunemann, and E. M. Ohman Thrombolysis and Adjunctive Therapy in Acute Myocardial Infarction: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 549S - 575S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. C. Keeley and C. L. Grines Primary Coronary Intervention for Acute Myocardial Infarction JAMA, February 11, 2004; 291(6): 736 - 739. [Full Text] [PDF]
|
|
|
|
|
|
H. L. Dauerman and B. E. Sobel Synergistic treatment of ST-segmentelevation myocardial infarction with pharmacoinvasive recanalization J. Am. Coll. Cardiol., August 20, 2003; 42(4): 646 - 651. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 U. Stenestrand and L. Wallentin Fibrinolytic Therapy in Patients 75 Years and Older With ST-Segment-Elevation Myocardial Infarction: One-Year Follow-up of a Large Prospective Cohort Arch Intern Med, April 28, 2003; 163(8): 965 - 971. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. S. Rathore, K. P. Weinfurt, C. P. Gross, and H. M. Krumholz Validity of a Simple ST-Elevation Acute Myocardial Infarction Risk Index: Are Randomized Trial Prognostic Estimates Generalizable to Elderly Patients? Circulation, February 18, 2003; 107(6): 811 - 816. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The Task Force on the Management of Acute Myocardi, F. Van de Werf, D. Ardissino, A. Betriu, D. V. Cokkinos, E. Falk, K. A.A. Fox, D. Julian, M. Lengyel, F.-J. Neumann, et al. Management of acute myocardial infarction in patients presenting with ST-segment elevation Eur. Heart J., January 1, 2003; 24(1): 28 - 66. [Full Text] [PDF]
|
|
|
|
|
|
S. W. Smith, J. H. Gurwitz, T. J. McLaughlin, D. Ross-Degnan, C. L. Christiansen, and S. B. Soumerai Thrombolytics Are Not Contraindicated in the Very Old Arch Intern Med, October 14, 2002; 162(18): 2139 - 2140. [Full Text] [PDF]
|
|
|
|
|
|
M.-J. de Boer, J.-P. Ottervanger, A. W. J. van't Hof, J. C. A. Hoorntje, H. Suryapranata, F. Zijlstra, and the Zwolle Myocardial Infarction Study Group Reperfusion therapy in elderly patients with acute myocardial infarction: A randomized comparison of primary angioplasty and thrombolytic therapy J. Am. Coll. Cardiol., June 5, 2002; 39(11): 1723 - 1728. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. R. Thiemann Primary angioplasty for elderly patients with myocardial infarction: Theory, practice and possibilities J. Am. Coll. Cardiol., June 5, 2002; 39(11): 1729 - 1732. [Full Text] [PDF]
|
|
|
|
 |
|
 P. Abete, G. Testa, N. Ferrara, D. De Santis, P. Capaccio, L. Viati, C. Calabrese, F. Cacciatore, G. Longobardi, M. Condorelli, et al. Cardioprotective effect of ischemic preconditioning is preserved in food-restricted senescent rats Am J Physiol Heart Circ Physiol, June 1, 2002; 282(6): H1978 - H1987. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J M Estess and E J Topol Fibrinolytic treatment for elderly patients with acute myocardial infarction Heart, April 1, 2002; 87(4): 308 - 311. [Full Text] [PDF]
|
|
|
|
|
|
P. Abete, N. Ferrara, F. Cacciatore, E. Sagnelli, M. Manzi, V. Carnovale, C. Calabrese, D. de Santis, G. Testa, G. Longobardi, et al. High level of physical activity preserves the cardioprotective effect of preinfarction angina in elderly patients J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1357 - 1365. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. R. Thiemann and S. P. Schulman Thrombolytics in elderly patients: A triumph of hope over experience? Can. Med. Assoc. J., May 1, 2001; 164(9): 1301 - 1303. [Full Text] [PDF]
|
|
|
|
 |
|
 Thrombolytics vs. Angioplasty in Elderly MI Patients Journal Watch Cardiology, October 27, 2000; 2000(1027): 5 - 5. [Full Text]
|
|
|
|
 |
|
 Reperfusion for Acute MI Reduces Mortality in the Elderly Journal Watch Emergency Medicine, October 3, 2000; 2000(1003): 2 - 2. [Full Text]
|
|
|
|
|
|
P. Abete, G. Testa, N. Ferrara, D. De Santis, P. Capaccio, L. Viati, C. Calabrese, F. Cacciatore, G. Longobardi, M. Condorelli, et al. Cardioprotective effect of ischemic preconditioning is preserved in food-restricted senescent rats Am J Physiol Heart Circ Physiol, June 1, 2002; 282(6): H1978 - H1987. [Abstract] [Full Text] [PDF]
|
|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
