ABSTRACT
Increasing age is a potent risk factor for acute myocardial infarction (MI), and older patients with acute MI are more likely to develop electrical and mechanical complications, noncardiac complications such as pneumonia or vascular access problems, more severe debilitation, and prolonged hospital lengthofstay and post-discharge recovery. Older patients thus comprise a large high-risk subgroup of the MI population who may derive substantial benefits from appropriately selected therapeutic interventions. At the same time, many interventions are associated with increased risk in the elderly, so individualization of treatment is essential. Optimal therapy is based on a careful risk-benefit assessment of the available treatment options in conjunction with appropriate consideration of patient preferences. Although most therapeutic trials for acute MI have either excluded elderly patients or enrolled too few older subjects to permit definitive conclusions, therapies recommended for acute MI in elderly individuals are generally similar to those for younger patients, but with the need for careful attention to drug dosing, slow titration of medications, and careful selection of and timing for more aggressive interventions such as cardiac surgery or mechanical circulatory support. With continued aging of our population, the number of older individuals at risk for acute MI will rise commensurately, and clinicians will need to have greater awareness of the importance of prevention, early recognition, and meticulous, individualized care for elderly patients with acute MI.
