[Percutaneous coronary angioplasty in acute myocardial infarction in elderly patients].

BACKGROUND

Over 1/3 of all patients treated for acute myocardial infarction are elderly (over 70 years of age). Blood flow restoration in the infarct-related artery is a fundamental therapeutic strategy, however reperfusion therapy is rarely used in the elderly as compared with younger groups. Mortality and complication rates are much higher in the elderly than in younger patients irrespective of the type of reperfusion therapy. Elderly patients are modestly represented in studies undertaken to analyze the efficacy of various types of reperfusion therapy. For this reason the choice of an optimal therapy in acute myocardial infarction in the elderly remains an open question.

METHODS

In the I Department of Cardiology PCI has been the strategy of choice in the treatment of acute myocardial infarction. This is a retrospective analysis of early and late outcomes of primary coronary angioplasty in elderly patients with myocardial infarction. Between June 2001 and December 2003 four hundred and five (405) consecutive patients were admitted to our centre due to acute myocardial infarction. A group of 352 patients treated by primary coronary angioplasty was analyzed. Patients were divided into two subgroups one subgroup--over 70 years of age (84 patients) and the second one--below 70 years of age (268 patients) serving as controls. Early (in-hospital) and late (at 30 days, 6 and 12 months) outcomes were assessed.

RESULTS

The most important observation was that elderly patients with myocardial infarction may be safely and effectively treated with primary coronary angioplasty. In-hospital mortality (5.9% vs. 2.2%, p < 0.05) and the number of bleeding complications (9.5% vs. 4.1%, p < 0.05) were higher in the elderly than in younger patients, but still lower than in the studies where fibrinolysis was used as a reperfusion strategy. Another important fact was the relatively frequent use of a platelet glycoprotein IIb/IIIa inhibitor (abciximab) in the elderly group (46.4% patients).

CONCLUSIONS

Our results prove that these agents may also be safely administered in elderly patients with myocardial infarction. It is probable that the relatively frequent use of platelet glycoprotein IIb/IIIa inhibitors in our elderly patients was one of the reasons for lower early mortality as compared with the findings of other investigators.