open access

Vol 76, No 5 (2018)
Reviews
Published online: 2018-04-06
Submitted: 2018-04-04
Accepted: 2018-04-04
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Reperfusion treatment in acute myocardial infarction in elderly patients

Frans Van de Werf
DOI: 10.5603/KP.a2018.0092
·
Kardiol Pol 2018;76(5):830-837.

open access

Vol 76, No 5 (2018)
Reviews
Published online: 2018-04-06
Submitted: 2018-04-04
Accepted: 2018-04-04

Abstract

In this paper the current knowledge of reperfusion therapy in elderly patients with an ST-segment elevation acute myocardial infarction (STEMI) is summarised. Placebo-controlled trials of fibrinolytic agents, direct comparative trials of fibrinolytic agents and antithrombotic co-therapies, and randomised trials of primary percutaneous coronary intervention (PCI) versus fibrinolytic therapy as well as registries are briefly reviewed, focusing on the impact of age. The benefit and risk of a combined pharma-cological and mechanical approach is presented. Important differences between a “facilitated PCI” and a “pharmaco-invasive strategy”, particularly in older STEMI patients, are highlighted. It will become clear at the end of this review that the knowledge about the benefit and risk of reperfusion therapy in the elderly is still incomplete and that more clinical trials in the elderly are needed. Practical recommendations for elderly patients with STEMI based on the current knowledge have been provided.

Abstract

In this paper the current knowledge of reperfusion therapy in elderly patients with an ST-segment elevation acute myocardial infarction (STEMI) is summarised. Placebo-controlled trials of fibrinolytic agents, direct comparative trials of fibrinolytic agents and antithrombotic co-therapies, and randomised trials of primary percutaneous coronary intervention (PCI) versus fibrinolytic therapy as well as registries are briefly reviewed, focusing on the impact of age. The benefit and risk of a combined pharma-cological and mechanical approach is presented. Important differences between a “facilitated PCI” and a “pharmaco-invasive strategy”, particularly in older STEMI patients, are highlighted. It will become clear at the end of this review that the knowledge about the benefit and risk of reperfusion therapy in the elderly is still incomplete and that more clinical trials in the elderly are needed. Practical recommendations for elderly patients with STEMI based on the current knowledge have been provided.

Get Citation

Keywords

ST-segment elevation myocardial infarction, fibrinolysis, primary percutaneous coronary intervention, elderly

About this article
Title

Reperfusion treatment in acute myocardial infarction in elderly patients

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 76, No 5 (2018)

Pages

830-837

Published online

2018-04-06

DOI

10.5603/KP.a2018.0092

Bibliographic record

Kardiol Pol 2018;76(5):830-837.

Keywords

ST-segment elevation myocardial infarction
fibrinolysis
primary percutaneous coronary intervention
elderly

Authors

Frans Van de Werf

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