EDITORIAL

Fibrinolytic treatment for elderly patients with acute myocardial infarction

J M Estess, E J Topol

Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA

Correspondence to:
Correspondence to:
Dr Eric Topol, Department of Cardiology/F25, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA;
topole@ccf.org

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Although fibrinolytic treatment of elderly patients is generally accepted, questions have been raised recently about its safety and efficacy.

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Keywords: fribrinolytic treatment; elderly; acute myocardial infarction

Abbreviations: aPTT, activated partial tissue thromboplastin; CCP, Cooperative Cardiovascular Project; FTT, fibrinolytic therapy trialists, GISSI, gruppo Italiano per lo studio della sopravvivenza nell'infarcto miocardico; ISIS, international study of infarct survival; LBBB, left bundle branch block; MI, myocardial infarction; OR, odds ratio; SK, streptokinase t-PA, tissue plasminogen activator

Fibrinolytic treatment is the standard of care for eligible patients presenting early with acute ST segment elevation myocardial infarction (MI) to hospitals where rapid triage to primary angioplasty is unavailable. Although fibrinolytic treatment of elderly patients is generally accepted,¹ a recent paper raised questions about its safety and efficacy. In this editorial, we will review the relevant studies and provide perspective on this controversy.

The observational study by Thiemann and colleagues was conducted using the Cooperative Cardiovascular Project (CCP) database of 210 996 patients treated for acute myocardial infarction during February 1994 and July 1995.² Patients were excluded if they had absolute contraindications to fibrinolytic treatment, left bundle branch block (LBBB), were admitted to hospitals with on-site angioplasty, transferred between hospitals or had other potential confounders for the administration of fibrinolytics. Patients > 86 years of age (6156 patients) and those not receiving aspirin and/or heparin were also excluded. The . . . [Full text of this article]

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