[Thrombolysis after 75 years of age: benefits, risks, indications]

Hospital mortality of myocardial infarction in patients over 75 years of age ranges from 25 to 33% without thrombolysis. Large scale trials of intravenous thrombolytic therapy including elderly patients showed that age itself is not a contra-indication to thrombolytic therapy. However, on the one hand, contra-indications are more common, and, on the other, the characteristics of infarction in the elderly are unsuitable so that thrombolysis is rarely used: in the MITI study, only 15% of over 75 years old patients would have benefitted from this therapy. The benefits of this treatment in patients over 75 years of age have been demonstrated: they were significant in Collin's meta-analysis (hospital mortality 24.9 vs 28.8%). In a more recent analysis (FFT study) the benefits of thrombolytic therapy after 75 years of age were shown providing the delay of inclusion (< 6 hours) and classical electrocardiographic criteria (ST elevation) were respected. Moreover, age is a risk factor for cerebral haemorrhage (prevalence 2.08% in patients over 75 years of age in the GUSTO study). The results of this study showed that, despite the development of thrombolysis, age was the main risk factor for hospital mortality and was independent of other risk factors. Therefore, the indication of intravenous thrombolytic therapy in elderly patients should be considered with respect to the characteristics of infarction (delay, site, presence of subendocardial ischaemia), the contra-indication related to potential bleeding and the possibilities of performing emergency angioplasty.