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Which Heart Attack Treatments Are Best? Depends on Your Age

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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.

A surprising finding of this study is that while thrombolytics did not seem to increase a heart attack victim's chances during the initial 30 day period, patients who received the drugs did better in the long run. The patients who got either thrombolytic therapy or angioplasty had a lower death rate after one year than those who didn't.

"These are immediate measures, meaning we want to see an immediate result, says David Newman, MD. "We don't usually look at the long-term outcome of these measures." Newman is an emergency room physician at the University of Pittsburgh Medical Center and was not involved in the study.

The study authors admit that these findings are not clear. They write that it may reflect "the absence of a true benefit of thrombolytic therapy in older patients and a tendency to administer these agents to healthier patients."

Newman agrees. "The people who don't get treated with either thrombolytics or angioplasty may all be sicker to begin with. And the ones who get treated are all healthier. So that's why a better one-year survival rate isn't always as impressive as the 30 day survival rate."

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