Many randomized studies have revealed that reperfusion
therapy is an epochmaking treatment for acute
myocardial infarction (AMI). However, it is no clear whether it is equally beneficial in the elderly or not. In this study, we elucidated the clinical characteristics and effectiveness of reperfusion
therapy and discussed the optimal treatment for AMI in the elderly. The study population comprised 1,891 consecutive patients with AMI. The reinfarction rates and the rates of Killip class III or IV on admission increased with age. The mortality was significantly higher in the older subgroups. In the patients with first AMI within 24 hours of the onset and who underwent emergency catheterization, those accompanied by
hypercholesterolemia or with habitual smoking were significantly fewer in the older group. Although the Q-wave MI rate, the peak CPK level and the reperfusion rate were no different, the
low cardiac output condition, multi vessel disease and short-term mortality were significantly greater in the older group. The patients over 80-year-old were subdivided into three groups; those treated conventionally (G-C), those treated with intracoronary thrombolysis (G-T) and those treated with direct PTCA (G-A). The overall mortality did not differ among the three groups. However, in patients hospitalized after 1990, the mortality in G-A was significantly lower than in G-C. The prevalence of
bleeding complications between G-A and G-T did not differ. The patients in G-A showed greater improvement of the left ventricular wall motion and lower incidence of postinfarctional angina than other groups. Reperfusion
therapy by direct PTCA appears to be the optimal strategy for treatment of elder patients with AMI.