The older you are, the less the chance of thrombolytic therapy

Recent guidelines have acknowledged that thrombolytic therapy reduces the risk of death after an acute myocardial infarction (AMI), independently of age. To examine the age-related in-hospital AMI mortality rate and its determinants in a large cohort of patients, the Quebec Acute Coronary Care Working Group conducted an analysis involving a registry of 44 acute care Quebec hospitals that enrolled 3741 patients with AMI between January 1995 and May 1996. The study also sought to examine the age-related differences in the use of thrombolytic therapy with patients with AMI and the variables responsible for these variations.

The authors report that in-hospital mortality rates rose dramatically with age, from 2.1% among patients less than 55 years of age to 26.3% among those aged 85 years or older. Conversely, the use of thrombolytic therapy decreased with age, from 46.2% to 9.5% within the same age groups. Compared with patients less than 55 years of age, the odds ratio of receiving thrombolytic therapy were 0.68 (95% confidence interval [CI] 0.52-0.89), 0.48 (95% CI 0.35-0.65) and 0.13 (95% CI 0.06-0.26) for patients aged 65-74, 75-84 and 85 years or more, respectively.

In a related commentary, Drs. David Thiemann and Steven Schulman review the sometimes conflicting evidence on the effectiveness of thrombolytic therapy in elderly patients.

Age-related differences in in-hospital mortality and the use of thrombolytic therapy for acute myocardial infarction

� J-M Boucher et al

Thrombolytics in elderly patients:

A triumph of hope over experience?

� D.R. Thiemann, S.P. Schulman

Dr. Thiemann, of the Division of Cardiology, Johns Hopkins Hospital and University, Baltimore, Md. can be reached at 410-955-6558