NEW YORK (MedscapeWire) Mar 14 Although national guidelines encourage more frequent use of thrombolytics for acute myocardial infarction (MI), a retrospective cohort study in the March issue of the Archives of Internal Medicine suggests the need for caution in the elderly.
"Our findings raise concerns about the benefits of this treatment in the old-old, even those who might be considered eligible for treatment according to current criteria," write Stephen B. Soumerai, ScD, and colleagues from Harvard Medical School in Boston, Massachusetts.
A records review of 2659 elderly patients admitted with acute MI to 37 Minnesota community hospitals between 1992 and 1996 revealed that 63% of 719 eligible patients received thrombolytic therapy, but 27% of thrombolytic recipients had absolute contraindications to treatment.
Although 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 those who received thrombolytics vs those who did not.
In patients with at least 1 contraindication, thrombolytic therapy increased mortality risk by 57%. Eligible patients aged 80 to 90 years who received thrombolytics had a 40% higher risk of death than those who did not, although thrombolytic therapy in eligible patients younger than 80 years was associated with reduced mortality.