Considerations in reperfusion therapy of elderly patients with ST elevation acute myocardial infarction

Although the therapeutic benefit of coronary reperfusion-fibrinolytic therapy and primary percutaneous coronary intervention (PCI)-for the treatment of acute ST elevation myocardial infarction (STEMI) in younger patients is well established, there remains considerable debate over the appropriate choice of a reperfusion strategy for elderly patients. The difficulty in choosing the optimum reperfusion strategy stems from the uncertainty surrounding the data on the efficacy of fibrinolytic therapy in the elderly. Complicating the choice of a strategy for the elderly is the increased risk of bleeding associated with fibrinolytic therapy. Although the data for safety and efficacy for primary PCI are more convincing, primary PCI is not widely available as a reperfusion option (1).