Elderly people benefit from thrombolysis and should be included in trials

Patients older than 70 account for a third to a half of patients with acute myocardial infarction admitted to hospital,1 and 80% of deaths due to acute myocardial infarction occur in those aged over 65 years, 60% of them in people aged 75 or more.2 Despite extensive studies of thrombolytic treatments in large numbers of patients, we lack data on elderly subjects over 75 and particularly among those over 85. The size of the elderly population is growing: between 1982 and 1992 the Nottingham heart attack register recorded a 70% increase in patients aged 70-74 admitted with myocardial infarction anda 200% increase in those aged 75 or over.3 Hence we must be able to assess the optimal therapeutic strategies for such patients.

The application of trial results to clinical practice is hampered by the fact that such patients, although accounting for up to half of cases of myocardial infarction and having a disproportionately high mortality, are significantly underrepresented in clinical trials. Over …