Primary percutaneous coronary intervention in elderly patients with ST-elevation acute myocardial infarction

The elderly constitute a rapidly growing segment of our population and cardiovascular disease becomes more prevalent with increasing age, accounting for majority of their morbidity and mortality. ST-elevation acute myocardial infarction (STEMI) is the result of an abrupt cessation of blood supply caused by coronary occlusion, its process involving atherosclerotic plaque rupture or erosion, platelet aggregation and thrombus formation. Early, effective, and persistent recanalization of the infarct-related coronary artery and reperfusion of the myocardium are crucial for the improvement of left ventricular function and prognosis of the patients. However, the optimal therapeutic strategy or the risk/ benefit of reperfusion treatment for STEMI in the elderly remains an unsettled issue because previous large randomized clinical trials assessing reperfusion treatment of STEMI or the relative merits of mechanical versus pharmacological options have systematically excluded elderly patients, with only 10% to 15% of the population being older than 75 years of age.