Which Heart Attack Treatments Are Best? Depends on Your Age
July 31, 2000 -- When you have chest pains or other symptoms of a heart attack, getting emergency medical care should be foremost in your mind, no matter how old you are. But your age can make a difference in exactly which treatments work best, and -- especially if you are over 65 -- this might affect your very survival.
According to researchers from Yale University, thrombolytics -- the clot-busting drugs that are the main emergency treatment for heart attack victims nationwide -- do not appear to increase the survival rate for people over 65. Their study, which appears in the Journal of the American College of Cardiology, found there was no real difference in the short-term death rate (within 30 days of treatment) between patients who had received the therapy and those who had not.
But they did find that older patients who underwent angioplasty had a better chance of surviving their heart attacks during that first, crucial 30 day period than either those who received no therapy or those who were treated with thrombolytics. Angioplasty is a commonly used procedure in which a doctor inserts a catheter with a deflated balloon into an artery around the heart. When the balloon is inflated, it enlarges the vessel and allows blood to flow more easily. But because of the manpower and equipment needed, angioplasty, especially on an emergency basis, is not available at all hospitals.
"This study is important because it can help us decide which are the best methods for treating elderly patients with a suspected heart attack," Gregg Fonarow, MD, tells WebMD. "It confirms the benefits of angioplasty and confirms that thrombolytics have a minimal benefit in the elderly." Fonarow, who was not involved in the study, is an associate professor of medicine, division of cardiology, at the University of California in Los Angeles.
Led by Alan Berger, MD, from the department of medicine at Yale University School of Medicine, the researchers examined medical data from nearly 38,000 elderly patients who went to hospitals with symptoms of a heart attack. Only 4% had an angioplasty done to treat the heart attack, while about 38% were given thrombolytic drugs, and nearly 60% received no specific therapy.
Fonarow says this last statistic is alarming. "We have to wonder what happened to that other [more than] 50% [who received no therapy]. Thrombolytics can cause bleeding, so there can be a reluctance to give it to elderly persons. Making a diagnosis [of a heart attack] can also be difficult. But for some of them, if the diagnosis had been made promptly, then they would have been candidates for angioplasty."
The study also showed that the patients who received the clot busters had a lower rate of chest pain, or angina, following their heart attack, as well as a lower risk of going into heart failure. But the trade-off was that they appeared to be more prone to other complications. Older patients treated with the drugs faced a higher risk of stroke and bleeding and were more likely to later undergo procedures such as cardiac catheterization with or without angioplasty or bypass surgery.