Acute MI in the elderly: choosing the best revascularization method. Risks and benefits of thrombolysis, angioplasty, and bypass surgery.

MI is often recognized less promptly in elderly patients than in younger patients; thus, the best opportunity for reperfusion is often missed. If infarction is diagnosed in less than 12 hours and there are no strong contraindications, thrombolytic therapy is appropriate for the elderly. Coronary angioplasty is a suitable alternative if performed promptly, especially because elderly patients are more likely to have contraindications to, or higher mortality from, thrombolysis. Predictors of unfavorable outcome following angioplasty for acute MI in the elderly include multivessel disease, occlusion of the infarcted artery, and cardiogenic shock. CABG surgery (performed during infarction or in the peri-infarct setting) is also an option for those elderly patients who are hemodynamically stable.