[Acute myocardial infarction in elderly patients: feasibility of transradial intervention and rapid mobilization]

Rapid mobilization and discharge following rapid acute phase reperfusion are recommended for elderly patients with acute myocardial infarction to achieve a better outcome and performance. The safety and efficacy of new and old treatment protocols were retrospectively compared for patients with acute myocardial infarction.

The new protocol used transradial intervention, encouraged stent implantation, beta-blocker administration, and rapid mobilization for rapid discharge (10-14 day hospital stay). The previous protocol used transfemoral intervention, bed rest and late mobilization, and discouraged stent implantation and beta-blocker supplementation. High risk patients with cardiogenic shock, left main disease, malignant arrhythmia and impending myocardial rupture were excluded from the study.

Thirty-two patients were treated by the new protocol, and 57 patients by the old protocol. The former included more elderly patients (p < 0.05). The prevalence of beta-blocker use (63.3% vs 18.8%, p < 0.001) and stent implantation (43.8% vs 3.5%, p < 0.05) were higher in the new protocol group. Hospital stay (23.6 +/- 9.5 vs 13.3 +/- 5.9 days, p < 0.001) and intensive care unit stay (4.4 +/- 3.0 vs 2.4 +/- 1.2 days, p < 0.001) were shorter in the new protocol than in the old protocol group. Rates of in-hospital death, cardiac events, systemic complications and left ventricular function (left ventricular ejection fraction and left ventricular end-diastolic volume index at admission and discharge) were not significantly different between the 2 groups. The prevalence of systemic complications (including delirium) among patients older than 70 years was lower in the new protocol group (4.7% vs 11.7%, p < 0.05).

The new protocol can shorten hospital stay with no increase in in-hospital death or cardiac events, or decline of left ventricular function. Moreover, the new protocol is potentially effective for reducing systemic complications among elderly patients. Therefore, this protocol can be recommended for elderly patients with acute myocardial infarction.