Management of acute myocardial infarction in the elderly
Donald D. Tresch, MDAddress reprint requests to D.D.T., Medical College of Wisconsin, 8700 West Wisconsin Avenue, Box 123, Milwaukee, WI 53226.
Duane Berkompas, MD
Thrombolysis and other new therapies have proved beneficial in elderly patients with myocardial infarction, but are underused in this age group.
Because elderly patients are at greater cardiac risk than younger patients, they have more to gain from treatment. However, these treatments may pose more risk for elderly patients. Physicians must constantly assess the elderly patient's risk status and make treatment decisions based on risk-benefit analysis.KEY POINTS
Streptokinase may be as beneficial as tissue-plasminogen activator in older patients. Aspirin is recommended for all patients.
Long-term anticoagulation therapy is reserved for patients at risk of thromboembolic events.
Beta blockers are beneficial but underused in older patients, even in patients who have no contraindications to them.
Coronary artery bypass grafting and percutaneous transluminal coronary angioplasty produce excellent results in selected elderly patients.
Angiotensin-converting enzyme inhibitors are recommended for all patients who have a left ventricular ejection fraction of 40% or less.
Empirical use of antiarrhythmic drugs lacks benefit, but elderly patients with life-threatening ventricular tachyarrhythmias do benefit from aggressive management guided by electrophysiologic studies.