Medical Therapy for Elderly Patients Who Have Had Myocardial Infarction: Too Little to the Late in Life?
Authors: Jeffrey L. Anderson
Journal: Annals of Internal Medicine (1996)

Editorials1 February 1996Medical Therapy for Elderly Patients Who Have Had Myocardial Infarction: Too Little to the Late in Life?Jeffrey L. Anderson, MDJeffrey L. Anderson, MDUniversity of Utah School of Medicine Salt Lake City, UT 84143Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-124-3-199602010-00009 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Despite striking progress, cardiovascular diseases remain the leading cause of death in the United States [1]. The short- and long-term effects of myocardial infarction contribute most to this toll. Because the elderly are at greater risk for both total coronary heart disease and death related to acute myocardial infarction (risks increased 6-fold for persons 75 to 84 years of age and 15-fold for those aged 85 years and older compared with persons aged 55 to 64 years) [2], application of effective preventive and treatment measures might be associated with particularly large survival benefits. In this issue, two articles [3, 4] ...References1. McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA. 1993; 270:2207-12. Google Scholar2. “Vital Statistics of the United States. Compiled by the American Heart Association National Center. Dallas, TX: American Heart Association; 1995.” Google Scholar3. Gurwitz JH, Gore JM, Goldberg RJ, Rubison M, Chandra N, Rogers WJ, et al. Recent age-related trends in the use of thrombolytic therapy in patients who have had acute myocardial infarction. Ann Intern Med. 1996; 124:283-91. Google Scholar4. 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ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Lancet. 1988; 2:349-60.” Google Scholar9. Gunnar RM, Passamani ER, Bourdillon PD, Pitt B, Dixon DW, Rapaport E, et al. Guidelines for the early management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee to Develop Guidelines for the Early Management of Patients with Acute Myocardial Infarction). J Am Coll Cardiol. 1990; 16:249-92. Google Scholar10. “Secondary prevention of vascular disease by prolonged antiplatelet treatment. Antiplatelet Trialists' Collaboration. Br Med J (Clin Res Ed). 1988; 296:320-31.” Google Scholar11. Cannon CP, Henry TD, Schweiger MJ, Haugland JM, McKendall GR, Shah PK, et al. Current management of ST elevation myocardial infarction and outcome of thrombolytic ineligible patients: results of the multicenter TIMI 9 registry [Abstract]. J Am Coll Cardiol. 1995; 25:231A. Google Scholar12. Simoons ML, Arnold AE. Tailored thrombolytic therapy. A perspective. Circulation. 1993; 88:2556-64. Google Scholar13. Simoons ML, Maggioni AP, Knatterud G, Leimberger JD, de Jaegere P, van Domburg R, et al. Individual risk assessment for intracranial hemorrhage during thrombolytic therapy. Lancet. 1993; 342:1523-8. Google Scholar14. “An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. The GUSTO investigators. N Engl J Med. 1993; 329:673-82.” Google Scholar15. “Comparison of invasive and conservative strategies after treatment with intravenous tissue plasminogen activator in acute myocardial infarction. Results of the Thrombolysis in Myocardial Infarction (TIMI) Phase II Trial. The TIMI Study Group. N Engl J Med. 1989; 320:618-27.” Google Scholar16. Antman EM. Hirudin in acute myocardial infarction. Safety report from the Thrombolysis and Thrombin Inhibition in Myocardial Infarction (TIMI) 9A Trial. Circulation. 1994; 90:1624-30. Google Scholar17. “Randomized trial of intravenous heparin versus recombinant hirudin for acute coronary syndromes. The Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) Ila Investigators. Circulation. 1994; 90:1631-7.” Google Scholar18. “Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Gruppo Italiano per Io Studio della Streptochinasi nell'Infarto Miocardio (GISSI). Lancet. 1986; 1:397-402.” Google Scholar19. Martin GC, Kennedy JW. Choice of thrombolytic agent. In: Julian D, Braunwald E, eds. Management of Acute Myocardial Infarction. Philadelphia: WB Saunders; 1994:71-106. Google Scholar20. Maggioni AP, Maseri A, Fresco C, Mauri F, Santoro E, Tognoni G. Age-related increase in mortality among patients with first myocardial infarctions treated with thrombolytic therapy. The Investigators of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardio (GISSI-2). N Engl J Med. 1993; 329:1442-8. Google Scholar Author, Article, and Disclosure InformationAuthors: Jeffrey L. Anderson, MDAffiliations: University of Utah School of Medicine Salt Lake City, UT 84143Corresponding Author: Jeffrey L. Anderson, MD, Division of Cardiology, LDS Hospital, 8th Avenue and C Street, Salt Lake City, UT 84143. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoRecent Age-Related Trends in the Use of Thrombolytic Therapy in Patients Who Have Had Acute Myocardial Infarction Jerry H. Gurwitz , Joel M. Gore , Robert J. Goldberg , Michael Rubison , Nisha Chandra , and William J. Rogers Aspirin for Secondary Prevention after Acute Myocardial Infarction in the Elderly: Prescribed Use and Outcomes Harlan M. Krumholz , Martha J. Radford , Edward F. Ellerbeck , John Hennen , Thomas P. Meehan , Marcia Petrillo , Yun Wang , and Stephen F. Jencks Metrics Cited byDiferencias en el manejo del infarto agudo de miocardio según la edad en los hospitales de Navarra. Estudio IBERICAAge-associated time delays in the treatment of acute myocardial infarction with primary percutaneous transluminal coronary angioplastyPost myocardial infarction treatment in the older adultDecade-long trends (1986 to 1997) in the medical treatment of patients with acute myocardial infarction: A community-wide perspectivePost Myocardial Infarction Treatment in the Older AdultEDITORIALAnálisis del consumo de medicamentos utilizando indicadores de calidad en la prescripciónThe Treatment and Prevention of Coronary Heart Disease in Canada: Do Older Patients Receive Efficacious Therapies?Treatment for the Secondary Prevention of Stroke in Older Patients: The Influence of Dementia StatusAntiischemic Therapy in Patients with Coronary Heart Disease Living in Long-term CareEffect of Beta-Blockade on Mortality among High-Risk and Low-Risk Patients after Myocardial Infarction 1 February 1996Volume 124, Issue 3Page: 335-338KeywordsAcute myocardial infarctionAge groupsAntiplatelet therapyAspirinElderlyHemorrhageMortalityMyocardial infarctionSt segment elevation myocardial infarctionStroke ePublished: 15 August 2000 Issue Published: 1 February 1996 Copyright & PermissionsCopyright © 1996 by American College of Physicians. 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