Primary angioplasty with routine stenting compared with thrombolytic therapy in elderly patients with acute myocardial infarction

Background Prior studies have yielded conflicting data on the advantage of primary angioplasty compared with thrombolysis in elderly patients with acute myocardial infarction (AMI). These studies, however, were performed before the contemporary widespread use of intracoronary stents and glycoprotien IIb/IIIa antagonists. Methods we prospectively compared the outcome of 130 consecutive elderly patients (aged greater than or equal to70 years) with ST-elevation AMI who were admitted to 2 similar neighboring medical centers. Patients were assigned to receive either thrombolytic therapy with accelerated tissue-type plasminogen activator (center 1) or primary angioplasty with routine stenting (center II). Results Of the patients assigned to receive primary angioplasty, 91% underwent stenting. At 6 months, patients treated with primary angioplasty, compared with those treated with thrombolytic therapy, had a lower incidence of reinfarction (2% vs 14%, P = .053) and revascularization for recurrent ischemia (9% vs 61%, P < .001) and a significant reduction in the prespecified combined end point of death, reinfarction, or revascularization for recurrent ischemia (29% vs 93%, P < .01). Primary angioplasiy remained an independent predictor of the triple combined end point after controlling for potential covariables (relative risk 0.63, 95% Cl 0.38-0.84.). Major bleeding complications were also significantly reduced in the primary angioplasty group (0% vs 17%, P = .03). Conclusions Compared with thrombolysis, primary angioplasty with routine stenting in elderly patients with AM is associated with better clinical outcomes and a lower risk of bleeding complications.