Management of acute myocardial infarction in the elderly

Tresch, Donald D.; Berkompas, Duane

doi:10.3949/ccjm.62.3.156

Cited by 3 publications

(6 citation statements)

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“…Thrombolytic therapy, acute angioplasty, anticoagulants, and β‐adrenergic blockers improve outcome in younger patients 8–15 . Older patients also benefit from these interventions, but the risks are higher 16–21 . Multivessel CAD and comorbid conditions are more prevalent in older patients 16–21 .…”

Section: Discussionmentioning

confidence: 99%

“…All patients had 30 minutes or longer of chest pain, serum creatine kinase (CK) and myocardial band (MB) fraction more than two standard deviations (SDs) above normal, ST segment elevation or depression of 1.0 mm or more in two or more leads, and abnormal wall motion. We excluded 148 patients because of patient or physician refusal, (43) referral more than 7 days after acute infarction (30), technically inadequate echocardiography (5), hemodynamic instability for more than 7 days (50), or sustained ventricular tachycardia more than 24 hours after admission (20). We also excluded 65 patients (52 men and 13 women; 56 aged Ͻ 65 and nine aged Ն 65, P Ͻ .01) who underwent elective revascularization (coronary bypass surgery in 22 and percutaneous transluminal coronary angioplasty in 43) after dobutamine-atropine echocardiography and before hospital discharge.…”

Section: Patient Selectionmentioning

confidence: 99%

“…[8][9][10][11][12][13][14][15] Older patients also benefit from these interventions, but the risks are higher. [16][17][18][19][20][21] Multivessel CAD and comorbid conditions are more prevalent in older patients. [16][17][18][19][20][21] Early identification of high-risk older and younger patients may enhance the benefits of interventions.…”

Section: Previous Studiesmentioning

confidence: 99%

“…Reduced ventricular function, large infarct size, multivessel coronary artery disease (CAD), inducible ischemia, and age contribute to poor outcome 4–7 . Thrombolytic therapy, revascularization, anticoagulants, and β‐adrenergic blockers improve outcome 8–15 but carry greater risk in older patients 16–21 . Patient management may be optimized by awareness of age‐related mediators of morbidity and mortality 16–21 .…”

mentioning

confidence: 99%

“…Thrombolytic therapy, revascularization, anticoagulants, and β‐adrenergic blockers improve outcome 8–15 but carry greater risk in older patients 16–21 . Patient management may be optimized by awareness of age‐related mediators of morbidity and mortality 16–21 . Early assessment of risk may enhance the benefits of aggressive therapies in both age groups 3,12,14 …”

mentioning

confidence: 99%

See 4 more Smart Citations

Age‐Related Determinants of Outcome After Acute Myocardial Infarction: A Dobutamine‐Atropine Stress Echocardiographic Study

Smart

Sagar

Tresch

2002

J American Geriatrics Society

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Section: Discussionmentioning

confidence: 99%

Section: Patient Selectionmentioning

confidence: 99%

Section: Previous Studiesmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Age‐Related Determinants of Outcome After Acute Myocardial Infarction: A Dobutamine‐Atropine Stress Echocardiographic Study

Smart

Sagar

Tresch

2002

J American Geriatrics Society

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Responding to symptoms and signs of acute myocardial infarction—How do you educate the public?: A social-psychologic approach to intervention

Alonzo

Reynolds

1997

Heart & Lung

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Streptokinase

Gillis¹,

Goa²

1996

PharmacoEconomics

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Thrombolytic therapy with streptokinase and other agents reduces mortality and is now well accepted as the mainstay of revascularisation options for most patients after an acute myocardial infarction. Streptokinase is as efficacious as alteplase (recombinant tissue plasminogen activator; rt-PA) when given as a 3-hour infusion, anistreplase, reteplase and saruplase in reducing mortality. However, in the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) trial, an accelerated alteplase regimen (1.5-hour infusion) plus intravenous heparin demonstrated a statistically significant 1% absolute mortality reduction compared with streptokinase plus heparin. Treatment with streptokinase is consistently clinically superior to conventional treatment and is cost effective: the marginal cost per year of life saved (cost/YLS) is less than $US/$Can20,000 (1990 or 1991 currency) assuming 5-year survival. In addition, streptokinase treatment is associated with fewer intensive care days and total days spent in hospital and a decrease in the use of intensive care services compared with conventional therapy. Importantly, the cost/YLS of treating older patients (70 to 80 years) with streptokinase is similar to that in younger patients (approximately $US22,000, 1990 currency). In 1 study, the cost of in-hospital treatment and associated 1-year follow-up costs did not differ significantly regardless of whether patients received streptokinase or anistreplase. In the most comprehensive cost-effectiveness analysis to date, GUSTO investigators determined that the incremental cost/YLS in patients who received the accelerated alteplase regimen instead of streptokinase was $US32,678 (1993 currency); the projected life expectancy was about 15 years. Thrombolytic therapy is generally more cost effective in patients at high risk than in those at low risk. The cost effectiveness of streptokinase is dependent on infarct location and time to treatment, but is more favorable in patients with anterior than inferior infarctions and those treated as soon as possible after symptom onset. There are as yet no comparative data to indicate a clinical benefit for one thrombolytic agent over another in patients treated more than 6 hours after symptom onset; therefore, in all likelihood, streptokinase will be preferred on the basis of cost minimisation. Streptokinase is associated with a slightly higher rate of severe bleeding than alteplase but a lower incidence of stroke. Although quality-of-life information comparing thrombolytics is unavailable, most patients who received streptokinase or alteplase rated their quality of life as high on the basis of results from time trade-off assessments and health surveys. In summary, streptokinase is undeniably cost effective compared with conventional treatment. It is up to individual healthcare systems to determine whether the mortality advantage and cost differential of the accelerated alteplase regimen over streptokinase, as seen in the GUSTO trial, are afforda...

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Management of acute myocardial infarction in the elderly

Cited by 3 publications

References 0 publications

Age‐Related Determinants of Outcome After Acute Myocardial Infarction: A Dobutamine‐Atropine Stress Echocardiographic Study

Age‐Related Determinants of Outcome After Acute Myocardial Infarction: A Dobutamine‐Atropine Stress Echocardiographic Study

Responding to symptoms and signs of acute myocardial infarction—How do you educate the public?: A social-psychologic approach to intervention

Streptokinase

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