Therapy for acute myocardial infarction

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 deep venous thrombosis, and prolonged hospital length-of-stay and post-discharge recovery after MI. 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 older adults, 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 older patients or enrolled too few older subjects to permit definitive conclusions, therapies recommended for acute MI in older 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 and timing of more aggressive interventions such as coronary revascularization 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 older patients with acute MI.