Related Experiment Video
Updated: Mar 30, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
[A case review: About a STEMI in the very elderly]
P Dupouy1, D Pongas1, V Rubimbura1
1Pôle cardiovasculaire Antony-Melun, hôpital privé d'Antony, 1, rue Velpeau, 92160 Antony, France; Clinique les Fontaines, 54, boulevard Aristide-Briand, 77000 Melun, France.
Insights
Primary angioplasty is recommended for very elderly patients (>90 years) with myocardial infarction, as age alone should not preclude reperfusion therapy. Survivors show comparable or better outcomes than their peers, justifying adherence to treatment guidelines.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Increasing prevalence of coronary artery disease in the aging population necessitates treatment strategies for very elderly patients (>90 years).
- Limited evidence-based medicine exists for this demographic, yet registries offer guidance.
Observation:
- Age should not be a contraindication for reperfusion therapies in myocardial infarction.
- Primary angioplasty demonstrates technical success rates similar to younger populations and is the preferred treatment.
- Radial arterial access is recommended for primary angioplasty in this age group.
Findings:
- Thrombolysis has not been studied in patients >90 years, unlike in octogenarians.
- While complications like bleeding, neurological, and ischemic events are more frequent, survivors experience similar or improved survival rates.
- Initial hemodynamic compromise increases complication risks.
Implications:
- Primary angioplasty via radial access is a viable and effective treatment for very elderly myocardial infarction patients.
- Adherence to therapeutic recommendations, considering comorbidities and organ function, is crucial for optimizing outcomes in this population.
- Further research is needed to establish evidence-based guidelines for thrombolytic therapy in patients >90 years.
Abstract:
Because of the demographic growth of our societies and the increasing prevalence of coronary artery disease with age, we will be increasingly faced with the treatment of myocardial ST+ very elderly patients (>90 years?). If evidence-based medicine does not exist within this framework, there are many registries that can guide us in their care. First, age should not in itself be an indication against reperfusion conventional techniques. In fact recommendations put no upper age limit. The primary angioplasty technical success, which is identical to the younger populations, is the treatment of choice and should be performed preferably by radial arterial access. The thrombolytic alternative, validated for octogenarians, has not been studied for older. Bleeding, neurological, ischemic complications and hospital mortality are more common than in younger populations, especially as the initial hemodynamic alteration is important, but the survivors have the same life-threatening or even better than that of a same reference population ages. Which in itself even justifies maximum adhesion to the therapeutic recommendations taking into account the co-morbidities and possible visceral shortcomings.
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