Has Long-term Survival Improved for the Elderly with Acute Myocardial Infarction?

To determine the extent to which new therapies were applied and whether they were associated with improved survival in elderly myocardial infarction patients, we retrospectively reviewed all records of patients from one county treated in coronary care unit for acute myocardial infarction. All patients were 70 years or older during 1976-78 (n = 57), 1987 - 1989 (n = 195), 1991 (n = 88). Rates at which the medical technologies were applied, survival rates adjusted for comorbidity, and disease severity were compared for patients aged 70-79 and ≥80. The use of new therapies (reperfusion therapy, heparin, aspirin, nitrates, and bet blockers) increased over time. Likewise, the acute survival significantly improved over the three period; survival to discharge was 74%, 77%, and 92% for patients aged 70-79; 45%, 74%, and 81% for patients ≥ 80 (P < 0.02 for time period, P < 0.0001 for age). The improvement in acute survival was sustained during long-term follow-up for patients aged 70-79. However, the improvement was not sustained for patients aged ≥ 80. We conclude that, contrary to patients in their 70s, octogenarians have experienced short-term but not long-term benefit in survival from the application of new therapies to treat acute myocardial infarction.