What is the optimal reperfusion strategy for elderly patients with acute MI?

The overview of the Fibrinolytic Therapy Trialists' (FTT) Collaborative Group showed that, in more than 3000 elderly patients, thrombolytic treatment is effective in reducing mortality of patients with acute myocardial infarction with ST elevation within 12 hours from the onset of symptoms. Small-scale clinical trials confirmed the superiority of primary percutaneous coronary intervention even in older patients. However, clinical practice largely differs from the setting of clinical trials and, specifically, with respect to primary percutaneous coronary intervention. As a consequence, the results observed with percutaneous coronary intervention in "real world" patients seem to be less favorable than those obtained in trials. For this reason, reperfusion therapy with fibrinolytic agents remains the first choice of therapy for ST elevation myocardial infarction in the majority of hospitals where direct percutaneous coronary intervention facilities are not available.