A retrospective study of clinical limitations of reperfusion therapy for acute myocardial infarction

Abstract

We examined the clinical limitations of reperfusion therapy (RT) for acute myocardial infarction (AMI). The 1135 consecutive patients admitted to our institution from 1983 to 1993 were divided into two groups (Group RT, n=552 and Group C (Conservative Therapy), n=583). Each group was classified into older (or elderly) patients (aged≥75 years) and younger patients (aged <75 years). The patients in Group RT had significantly lower in-hospital mortality than Ggroup C (19.7% vs 11.4%, p<0.01), however there was no significant difference in the incidence of in-hospital death in the elderly between Group RT and C (23.1% vs 29.4%). Patients with complicattions from cardiogenic shock in Group RT had significantly lower mortality than in Group C (51.6% vs 82.0%, p<0.01), but it was still high (58.6%) in the elderly. There were no significant differences in causes and the age distribution of in-hospital deaths in Groups RT and C. Of the 63 patients who died during hospitalization in Group RT, 37 patients (59%) experienced pump failure caused by cardiogenic shock and 32 patients (51%) were more than 75 years old.These data showed the clinical limitations of RT for elderly patients and patients with cardiogenic shock in AMI.