 |
|
Effectiveness of Thrombolytic Therapy for Acute Myocardial Infarction in the Elderly
Cause for Concern in the Old-Old
Stephen B. Soumerai, ScD;
Thomas J. McLaughlin, ScD;
Dennis Ross-Degnan, ScD;
Cindy L. Christiansen, PhD;
Jerry H. Gurwitz, MD
Arch Intern Med. 2002;162:561-568.
Background National guidelines have encouraged increased use of thrombolytic therapy
for elderly patients with acute myocardial infarction (AMI). However, evidence
supporting thrombolytic therapy in patients 75 years and older is lacking.
In a retrospective cohort study of 2659 elderly AMI patients, we determined
the association between thrombolytic use and in-hospital mortality by age
and among patients with or without absolute or relative contraindications
to thrombolytic treatment.
Methods We abstracted the medical records of 2659 elderly patients admitted
with AMI at 37 Minnesota community hospitals between 1992 and 1996. The main
outcome measure was in-hospital mortality, controlling for demographic, clinical,
comorbidity, and severity-of-illness variables.
Results Sixty-three percent of 719 eligible patients received thrombolytic therapy.
Twenty-seven percent of thrombolytic recipients had absolute contraindications
to treatment. Patients receiving thrombolytic agents had fewer and less severe
comorbidities than those not receiving thrombolytic therapy. There was a 4%
increase in the odds of death for every 1-year increase in age for all thrombolytic
recipients vs nonrecipients (odds ratio [OR], 1.04 per year; 95% confidence
interval [CI], 1.01-1.08; P = .03). Among patients
with 1 or more contraindication, the OR for death associated with thrombolytic
use was 1.57 (95% CI, 1.03-2.40; P = .04). The adjusted
odds of death among eligible thrombolytic recipients (vs nonrecipients) increased
significantly with age (OR, 1.08 per year; 95% CI, 1.02-1.14; P = .008). Among eligible patients aged 80 to 90 years, the predicted
odds of death among thrombolytic recipients vs nonrecipients was 1.4. Among
eligible patients younger than 80 years, thrombolytic use was associated with
reduced mortality.
Conclusions Our findings suggest the need for more research on the effectiveness
of thrombolytic therapy for AMI patients 75 years and older and for more careful
selection of elderly patients for this treatment.
From the Department of Ambulatory Care and Prevention, Harvard Medical
School and Harvard Pilgrim Health Care, Boston, Mass (Drs Soumerai, McLaughlin,
and Ross-Degnan); the Boston University School of Public Health, Health Services
Department and Center for Health Quality, Outcomes, and Economic Research
at Veterans Affairs Health Services Research and Development, Bedford, Mass
(Dr Christiansen); and The Meyers Primary Care Institute, University of Massachusetts
Medical School, and the Fallon Healthcare System, Worcester (Dr Gurwitz).
RELATED ARTICLE
Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 2002;162(5):615.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Acute Coronary Care in the Elderly, Part II: ST-Segment-Elevation Myocardial Infarction: A Scientific Statement for Healthcare Professionals From the American Heart Association Council on Clinical Cardiology: In Collaboration With the Society of Geriatric Cardiology
Alexander et al.
Circulation 2007;115:2570-2589.
ABSTRACT
| FULL TEXT
The Impact of Percutaneous Coronary Interventions on Outcomes for Acute Myocardial Infarction in Pennsylvania
Hollenbeak et al.
American Journal of Medical Quality 2007;22:85-94.
ABSTRACT
Informal caregivers and the risk of nursing home admission among individuals enrolled in the program of all-inclusive care for the elderly.
Friedman et al.
Gerontologist 2006;46:456-463.
ABSTRACT
| FULL TEXT
Coronary care unit admission of very old patients with acute myocardial infarction.
Martinez-Selles et al.
Heart 2006;92:549-550.
FULL TEXT
Overestimation of clinical diagnostic performance caused by low necropsy rates
Shojania et al.
Qual Saf Health Care 2005;14:408-413.
ABSTRACT
| FULL TEXT
Effect of thrombolytic therapy on the risk of cardiac rupture and mortality in older patients with first acute myocardial infarction
Bueno et al.
Eur Heart J 2005;26:1705-1711.
ABSTRACT
| FULL TEXT
Management and Outcomes of Elderly Women and Men With Acute Coronary Syndromes in 2000 and 2002
Moriel et al.
Arch Intern Med 2005;165:1521-1526.
ABSTRACT
| FULL TEXT
Predictors of In-Hospital Mortality in Patients With Acute Ischemic Stroke Treated With Thrombolytic Therapy
Heuschmann et al.
JAMA 2004;292:1831-1838.
ABSTRACT
| FULL TEXT
Outcome in Elderly Patients Undergoing Primary Coronary Intervention for Acute Myocardial Infarction: Results From the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Trial
Guagliumi et al.
Circulation 2004;110:1598-1604.
ABSTRACT
| FULL TEXT
Prospective Evaluation of Clinical Outcomes After Acute ST-Elevation Myocardial Infarction in Patients Who Are Ineligible for Reperfusion Therapy: Preliminary Results From the TETAMI Registry and Randomized Trial
Cohen et al.
Circulation 2003;108:III-14-21.
ABSTRACT
| FULL TEXT
Synergistic treatment of ST-segmentelevation myocardial infarction with pharmacoinvasive recanalization
Dauerman and Sobel
J Am Coll Cardiol 2003;42:646-651.
ABSTRACT
| FULL TEXT
Editorial: Hot Topics in Geriatrics
Morley
J. Gerontol. A Biol. Sci. Med. Sci. 2003;58:M30-36.
FULL TEXT
Thrombolytics Are Not Contraindicated in the Very Old
Smith et al.
Arch Intern Med 2002;162:2139-2140.
FULL TEXT
|
