Heart attack patients over the age of 75 are less likely to betreated early -- or even at all -- with thrombolytic therapythan younger individuals, according to an analysis of data on130,367 patients enrolled in the National Registry ofMyocardial Infarction (NRMI).
Moreover, elderly patients who do receive thrombolytictherapy are more likely to die the longer that therapy isdelayed.
Joel Gore, the director of the division of cardiovascularmedicine at the University of Massachusetts Medical School,Worcester, presented his analysis of the NRMI data Thursdayat the American College of Cardiology Meeting in Anaheim,Calif.
Gore found that patients over the age of 75 treated withrecombinant tissue plasminogen activator (t-PA) had amortality rate of 18.5 percent, while for those who did notreceive thrombolytic therapy, the rate was 22.5 percent.
Additionally, Gore found that elderly patients were lessfrequently given aspirin with thrombolytics (78.7 percent over75 vs. 83.7 percent under 65) or without thrombolytics (52.5percent vs. 66.3 percent). And time-to-treatment makes adifference in survival in older patients, with males outlastingfemales.
When thrombolytic therapy was administered within six hoursof the onset of chest pain, 4 percent of the males died, but 7.9percent of the females succumbed. If the therapy was delayed12 to 24 hours, 5.4 percent of the males and 9.1 percent of thefemales died.
Gore concluded that elderly patients need not be excluded fromthrombolytic therapy, despite the potential increased risk ofbleeding and intracranial hemorrhage. "Given the highmortality rate among elderly heart attack patients in general,even a small percent reduction in fatality translates into a largeabsolute benefit in additional lives saved," he said. "The earliera patient is treated with thrombolytics, the better chance thereis in salvaging the greatest amount of heart muscle."
-- Jennifer Van Brunt Senior Editor
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