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CLINICAL STUDY

Reperfusion therapy in elderly patients with acute myocardial infarction

A randomized comparison of primary angioplasty and thrombolytic therapy

^* Department of Cardiology, Isala Clinics location "de Weezenlanden," Zwolle, Netherlands

Manuscript received July 12, 2001; revised manuscript received March 4, 2002, accepted March 13, 2002.

^* Reprint requests and correspondence: Dr. Menko-Jan de Boer, Department of Cardiology, Isala Klinieken lokatie "de Weezenlanden," Groot Wezenland 20, 8011 JW, Zwolle, Netherlands.
ereis{at}planet.nl

OBJECTIVES: 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.

Abbreviations and Acronyms   AMI   acute myocardial infarction   CI   confidence interval   ECG   electrocardiogram   IRV   infarct-related vessel   IV   intravenous   LDH   lactate dehydrogenase   PAMI   Primary Angioplasty for Myocardial Infarction study   RR   relative risk   TIMI   Thrombolysis In Myocardial Infarction

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