Pharmacological therapy for myocardial infarction in the elderly: An 8-year analysis.

Objective: To assess the changes in the medicamentous treatment of elderly patients hospitalized with acute myocardial infarction occurring over an 8-year period.

Methods: We retrospectively analyzed 379 patients above the age of 65 years with acute myocardial infarction who were admitted to the coronary unit of a university-affiliated hospital from 1990 to 1997. The patients were divided into 2 groups, according to the period of time of hospital admission as follows: group 1 - from 1990 to 1993; and group 2 - from 1994 to 1997.

Results: The use of beta-blockers (40.8% X 75.2%, p<0.0001) and angiotensin-converting enzyme inhibitors (42% X 59.5%, p=0.001) was significantly greater in group 2, while the use of calcium antagonists (42% X 18.5%, p<0.0001) and general antiarrhythmic drugs (19.1% X 10.8%, p=0.03) was significantly lower. No significant difference was observed in regard to the use of acetylsalicylic acid, thrombolytic agents, nitrate, and digitalis in the period studied. The length of hospitalization was shorter in group 2 (13.4+/-8.9 days X 10.5+/-7.5 days, p<0.001). The in-hospital mortality was 35.7% in group 1 and 26.6% in group 2 (p=0.07).

Conclusion: Significant changes were observed in the treatment of elderly patients with acute myocardial infarction, with a greater use of beta-blockers and angiotensin-converting enzyme inhibitors and a lower use of calcium antagonists and antiarrhythmic drugs in group 2. The length of hospitalization and the mortality rate were also lower in group 2, even though the reduction in mortality was not statistically significant.