Optimal revascularization strategies for ST-segment elevation myocardial infarction in the elderly patient

Patients older than 75 years account for >60% of all deaths from acute myocardial infarction. Although there are accepted guidelines for treatment of acute ST-segment elevation myocardial infarction, elderly patients tend to have a variety of conditions that can complicate decisions about the best therapy. Many elderly patients do not receive potentially lifesaving treatments, such as percutaneous coronary intervention or thrombolytic therapy, for fear of an adverse event. Those who do receive appropriate revascularization therapy often receive it later in the course of the infarct, when irreversible damage has occurred. Yet studies show that patients older than 75 years will benefit substantially from these therapies. Early treatment improves outcomes in this population, as in younger patients, despite a higher risk of complications. In this review, the evidence regarding medical and revascularization therapies in ST-segment elevation myocardial infarction is critically examined.