Reperfusion strategies for acute myocardial infarction in the elderly
Benefits and risks
Rajendra H. Mehta, MD, MS*,
Christopher B. Granger, MD*,
Karen P. Alexander, MD*,
Eduardo Bossone, MD ,
Harvey D. White, MD and
Michael H. Sketch, Jr, MD*,*
* Duke Clinical Research Institute and Duke University Medical Center, Durham, North Carolina
National Research Council of Southern Italy, Brindisi, Italy
Auckland City Hospital, Auckland, New Zealand
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Figure 1 Benefits of thrombolytic therapy in different age groups. FTT = Fibrinolytic Therapy Trialists.
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Figure 2 Thirty-day mortality in patients randomized to primary coronary angioplasty versus intravenous thrombolysis in the Primary Coronary Angioplasty Trialists' Overview. Open bars = lytic; solid bars = percutaneous coronary intervention.
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Figure 3 Outcomes of patients undergoing primary percutaneous coronary interventions versus intravenous fibrinolysis from observational studies. *In-hospital mortality; **for ideal patients; +combined in-hospital mortality and stroke in patients with acute myocardial infarction without shock. PCI = percutaneous coronary intervention; TT = thrombolytic therapy.
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Figure 4 Thirty-day death, reinfarction, and recurrent angina in patients  75 years of age and in those >75 years of age treated with full-dose tenecteplase and enoxaparin (Enox) and half-dose teneteplase and full-dose abciximab (Abc) compared with those treated with full-dose abciximab and weight-adjusted unfractionated heparin (UFH).
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Figure 5 Risk of intracranial hemorrhage (ICH) in patients 75 years of age and in those age >75 years enrolled in Global Use of Strategies To Open occluded coronary arteries in acute myocardial infarction (GUSTO-V) and Assessment of Safety and Efficacy of a New Thrombolytic-3 (ASSENT-3) treated with half-dose thrombolytics and full-dose abciximab versus those treated with full-dose thrombolytics alone. Open bars = lytic; solid bars = lytic + glycoprotein IIb/IIIa.
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Figure 6 Recommended approach to reperfusion therapy for patients age  65 years with ST-segment elevation myocardial infarction. *Dose of weight-adjusted unfractionated heparin = 60 U/kg bolus (maximum 4,000 U) followed by infusion at 12 U/kg/h (maximum dose 1,000 U/h). CABG = coronary artery bypass grafting; EMS = emergency medical service; GP = glycoprotein; PCI = percutaneous coronary intervention.
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