Fibrinolytic therapy for acute ST-segment-elevation myocardial
infarction (STEMI) improves one-year survival outcomes for those aged
75 years or older, according to results of a large, prospective study
in the April 28 issue of the Archives of Internal Medicine. The study
investigators believe that this therapy should not be withheld on the
basis of age, at least not for those 75 to 85 years old.

"The main message from this large-scale registry study is that, in
the majority of elderly patients, fibrinolytic therapy is associated
with better outcome in the combined end point of 1-year mortality and
bleeding complications," write Ulf Stenestrand, MD, of University
Hospital of Linkoping in Sweden, and colleagues.

Although fibrinolytic therapy has been beneficial in some groups of
patients with STEMI, it has not been rigorously studied in older
populations, in part because of concerns that it may be associated
with increased risk of fatal bleeding.

Using the Register of Information and Knowledge About Swedish Heart
Intensive Care Admissions, which recorded every patient admitted to a
coronary care unit in 64 Swedish hospitals from 1995 through 1999,
the investigators identified 6,891 patients aged 75 years or older
with their first STEMI.

In 3,897 patients who received fibrinolytic therapy, there was a 13%
adjusted relative risk reduction in the combined endpoints of death
and complications from brain hemorrhage after one year, compared with
2,994 patients who did not receive fibrinolytic treatment (95%
confidence interval, 0.80 - 0.94; P = .001).

Study limitations include nonrandomized assignment of treatment and
possible unknown differences in background characteristics between
groups.

"Until results from randomized trials on fibrinolytic therapy in this
age group become available, there is no reason to withhold this
treatment from the elderly because of age, at least not before the
age of 85 years," the authors write. "On the contrary, our study, in
an unselected STEMI population, indicates that fibrinolytic therapy
might be lifesaving also in patients who are 75 years and older."

The authors have no relevant financial interests in this article.

Arch Intern Med. 2003;163:965-971