[Coronary angioplasty during the acute phase of myocardial infarction in the aged subject].

Myocardial infarction is a common and serious condition in patients over 70 years of age. The aim of this study was to assess the feasibility and efficacy of angioplasty without thrombolysis for revascularising an occluded artery in this age group. Between March 1986 and December 1989, 32 patients over 70 years of age (average 76 +/- 3 years) underwent angioplasty without thrombolysis in the acute phase of myocardial infarction. During the same period, 83 patients under 70 years of age were treated in the same manner. In the elderly subjects, the initial lesion was a total occlusion in 26 out of 32 cases (81%) and 99% stenosis in the other 6 cases (19%), and was successfully revascularised in 28 of the 32 patients (87.5%). Three episodes of ventricular fibrillation occurred during the procedure, one of which was lethal. A recurrence of pain during the hospital period was observed in 3 patients, 1 of whom died and the other 2 underwent repeat angioplasty. The hospital mortality was 5 patients (16%), all of whom were over 75 years of age. The comparison with patients under 70 years of age showed a comparable primary success rate, 87.5% (28/32) versus 92% (76/83) (p = 0.5), but a higher mortality, 16% (5/32) versus 4% (4/83) (p < 0.05) and a tendency to worse left ventricular function (ejection fraction 51% versus 62%) and to more extensive coronary artery disease; on the other hand, the post-hospital outcome was the same in both groups; Globally, emergency coronary angioplasty is a valuable alternative to thrombolysis for the treatment of myocardial infarction in patients over 70 years of age.