[Heart failure and myocardial infarction in the elderly. For its more specific management]

TWO NEGATIVE FACTORS: Heart failure, whether present during the first hours of myocardial infarction, whether it worsens or whether it occurs during the first days, or persists during the acute phase, is a highly unfavourable predictive factor of hospital mortality and mortality secondary to myocardial infarction. Furthermore, old age is the most negative predictive factor of late mortality following myocardial infarction.

These two negative predictive elements that considerably enhance immediate and secondary mortality after myocardial infarction, notably when they are combined, require more specific and voluntary management (in terms of medical--thrombolysis, beta-blockers, CEI--and interventional treatments) in these patients. THE NEED TO EXTEND THE INDICATIONS: Since the efficacy of these medical treatments and myocardial revascularisation techniques (during the acute phase in the case of contraindication for thrombolysis or during the secondary phase) is even greater, in terms of immediate and secondary mortality after myocardial infarction in patients at high risk (elderly patients and those suffering from heart failure), it would appear essential to widen their indications to this group of patients in whom the spontaneous prognosis is worst.