Thrombolytic Therapy Is Indicated for Patients Over 75 Years of Age With ST‐Elevation Acute Myocardial Infarction: Protagonist Viewpoint

Although the benefits of thrombolytic therapy are well established in patients younger than age 75 years with acute ST-elevation myocardial infarction, the value of thrombolytic treatment in patients 75 years of age or older remains controversial. This is due in part to conflicting data from clinical trials and observational studies and in part because of concerns about increased risk for major bleeding complications in the very elderly, particularly intracranial hemorrhage. However, in a recent meta-analysis based on data from 3322 patients aged 75 years or older presenting with ST-elevation myocardial infarction within 6 hours of symptom onset, thrombolytic therapy was associated with an absolute mortality reduction of 3.4% (26.0% vs. 29.4%), an effect similar to that seen in younger patients. In addition, although the risk of stroke increased with age, the absolute excess risk of stroke in patients older than age 75 years receiving thrombolytic treatment was <1%, and there was no age-associated excess in the risk of other major bleeding complications. These findings indicate that thrombolytic therapy is beneficial in carefully selected elderly patients with acute myocardial infarction and that the risk of major adverse events is acceptably low.