Primary Coronary Angioplasty vs Thrombolysis for the Management of Acute Myocardial Infarction in Elderly Patients

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Abstract
Acute myocardial infarction (AMI) is the leading cause of death in elderly patients. The choice of an optimal management strategy for patients with AMI has been addressed in multiple clinical trials and summarized in a meta-analysis of trials comparing thrombolysis with placebo. The meta-analysis found a significant benefit of thrombolysis in patients younger than 75 years, but only a trend toward decrease in mortality rates in patients aged 75 years or older.1 Supporters of primary percutaneous transluminal coronary angioplasty (PTCA) emphasize the procedure's higher early patency rate, lower rates of death and recurrent reinfarction, and markedly reduced rate of stroke. A recent meta-analysis of randomized clinical trials that compared thrombolytic therapy with primary PTCA suggests that PTCA decreases short-term mortality and the incidence of recurrent infarction.2 Observational studies in unselected patients have demonstrated similar outcomes in patients undergoing primary PTCA compared with those receiving thrombolysis.3,4