Lack of Benefit for Intravenous Thrombolysis in Patients With Myocardial Infarction Who Are Older Than 75 Years
David R. Thiemann,Josef Coresh,Steven P. Schulman,Gary Gerstenblith,William J. Oetgen,Neil R. Powe +5 more
TLDR
In nationwide clinical practice, thrombolytic therapy for patients >75 years old is unlikely to confer survival benefit and may have a significant survival disadvantage.Abstract:
Background—The benefit of intravenous thrombolytic therapy in elderly patients with myocardial infarction is uncertain. There are no randomized trials of thrombolytic efficacy or observational studies of clinical effectiveness that focus specifically on the elderly. Methods and Results—To determine whether thrombolytic therapy for elderly patients is associated with a survival advantage in a large observational database, we conducted a retrospective cohort study of 7864 Medicare fee-for-service patients aged 65 to 86 years with the primary discharge diagnosis of acute myocardial infarction who were admitted with clinical and ECG indications for thrombolytic therapy and no absolute contraindications. The study included all US acute care nongovernment hospitals without on-site angioplasty capability. Using proportional-hazards methods, we found that in a comprehensive multivariate model, there was a significant interaction (P<0.001) between age and the effect of thrombolytic therapy on 30-day mortality rate...read more
Citations
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ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction
Elliott M. Antman,Daniel T. Anbe,Paul W. Armstrong,Eric R. Bates,Lee A. Green,Mary M. Hand,Judith S. Hochman,Harlan M. Krumholz,Frederick G. Kushner,Gervasio A. Lamas,Charles J. Mullany,Joseph P. Ornato,David L. Pearle,Michael A. Sloan,Sidney C. Smith,Joseph S. Alpert,Jeffrey L. Anderson,David P. Faxon,Valentin Fuster,Raymond J. Gibbons,Gabriel Gregoratos,Jonathan L. Halperin,Loren F. Hiratzka,Sharon A. Hunt,Alice K. Jacobs +24 more
TL;DR: This document was approved by the American College of Cardiology Foundation Board of Trustees on May 7, 2004 and by theAmerican Heart Association Science Advisory and Coordinating Committee on May 5, 2004.
Journal ArticleDOI
Management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology.
Frans Van de Werf,Diego Ardissino,Amadeo Betriu,Dennis V. Cokkinos,Erling Falk,Keith A.A. Fox,Desmond G. Julian,Maria Lengyel,Franz-Josef Neumann,Witold Rużyłło,C. Thygesen,S. Richard Underwood,Alec Vahanian,Freek W.A. Verheugt,William Wijns +14 more
TL;DR: The management of acute myocardial infarction continues to undergo major changes as discussed by the authors, and good practice should be based on sound evidence derived from well-conducted clinical trials.
Journal ArticleDOI
Acute coronary care in the elderly, part I: Non-ST-segment-elevation acute coronary syndromes: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology.
Karen P. Alexander,L. Kristin Newby,Christopher P. Cannon,Paul W. Armstrong,W. Brian Gibler,Michael W. Rich,Frans Van de Werf,Harvey D. White,W. Douglas Weaver,Mary D. Naylor,Joel M. Gore,Harlan M. Krumholz,E. Magnus Ohman +12 more
TL;DR: Understanding the major contributors to benefits and risks from treatment will advance the ability to apply guideline-based care in this subset of patients, and prospective trials should enroll elderly subjects proportionate to their prevalence among the treated population to define risk and benefit.
Journal ArticleDOI
Representation of Elderly Persons and Women in Published Randomized Trials of Acute Coronary Syndromes
TL;DR: Women and elderly persons remain underrepresented in published trial literature relative to their disease prevalence because safety and efficacy can vary as a function of sex and age, and these enrollment biases undermine efforts to provide evidence-based care to all cardiac patients.
Journal ArticleDOI
Management of acute myocardial infarction in patients presenting with st-segment elevation
F. Van de Werf,Diego Ardissino,Amadeo Betriu,Dennis V. Cokkinos,Erling Falk,Keith A.A. Fox,Desmond G. Julian,Maria Lengyel,Franz-Josef Neumann,Witold Rużyłło,C. Thygesen,Richard Underwood,A Vahanian,Freek W.A. Verheugt,William Wijns +14 more
TL;DR: The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology is a group of doctors from around the world concerned with the management of acute myocardial infarction.
References
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An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction.
Maarten L. Simoons,Eric J. Topol,Robert M. Califf,Frans Van de Werf,Paul W. Armstrong,Philip Edmund Aylward,G.I. Barbash,Eric R. Bates,A. Betriu,James Chesebro,J Col,David de Bono,JM Gore,Alan Guerci,John R. Hampton +14 more
TL;DR: The findings of this large-scale trial indicate that accelerated t-PA given with intravenous heparin provides a survival benefit over previous standard thrombolytic regimens.
Journal Article
Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group.
TL;DR: 17,187 patients entering 417 hospitals up to 24 h after the onset of suspected acute myocardial infarction were randomized, with placebo control, between a 1 h intravenous infusion of streptokinase and 1 month of 160 mg/day enteric-coated aspirin.
Journal Article
急性心筋梗塞の疑いのある17187症例におけるストレプトキナーゼ静脈内投与,アスピリン経口投与,上記2つの併用または無処置の無作偽試験 isis-2
Journal Article
Indications for fibrinolytic therapy in suspected acute myocardial infarction : collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients
TL;DR: It is shown that fibrinolytic therapy can reduce mortality in patients with suspected acute myocardial infarction (AMI) and the indications for, and contraindications to, this therapy.
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ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction—Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction)
Elliott M. Antman,Daniel T. Anbe,Paul W. Armstrong,Eric R. Bates,Lee A. Green,Mary M. Hand,Judith S. Hochman,Harlan M. Krumholz,Frederick G. Kushner,Gervasio A. Lamas,Charles J. Mullany,Joseph P. Ornato,David L. Pearle,Michael A. Sloan,Sidney C. Smith,Joseph S. Alpert,Jeffrey L. Anderson,David P. Faxon,Valentin Fuster,Raymond J. Gibbons,Gabriel Gregoratos,Jonathan L. Halperin,Loren F. Hiratzka,Sharon A. Hunt,Alice K. Jacobs +24 more