Acute myocardial infarction in the elderly: differences by age (original) (raw)
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The Clinical Manifestation of Myocardial Infarction in Elderly Patients
Clinical Cardiology, 2009
Background and HypothesisThe study aimed to compare the clinical picture and treatment differences in elderly patients (aged 75 years or older) and younger patients (aged below 75 years).The study aimed to compare the clinical picture and treatment differences in elderly patients (aged 75 years or older) and younger patients (aged below 75 years).MethodsThe study included 80 consecutive patients with myocardial infarction (MI) treated in the Cardiology Ward of the Specialist Hospital in Radom, Poland, in 2005. Analyses were performed retrospectively. The patients were separated into 2 groups according to age. The group I study group consisted of 40 patients aged 75 or over (aged 75–95; mean 81 years) and the group II control group consisted of 40 patients aged below 75 years (aged 42–67; mean 60 years).The study included 80 consecutive patients with myocardial infarction (MI) treated in the Cardiology Ward of the Specialist Hospital in Radom, Poland, in 2005. Analyses were performed retrospectively. The patients were separated into 2 groups according to age. The group I study group consisted of 40 patients aged 75 or over (aged 75–95; mean 81 years) and the group II control group consisted of 40 patients aged below 75 years (aged 42–67; mean 60 years).ResultsIn the elderly, as compared with younger subjects, dyspnea, fatigue, and other heart failure symptoms, were more frequently the first symptoms of MI than typical chest pain (p<0.05). ST-segment elevation myocardial infarction (STEMI) was also more common (p<0.05). Non-ST-segment elevation myocardial infarction (NSTEMI) was more frequently diagnosed in the elderly (p<0.05). In elderly patients there were more women (p<0.05), more patients with previously diagnosed ischemic heart disease (p<0.05), with hypertension (p<0.05), and with diabetes mellitus (p<0.05). Obesity was less frequently diagnosed in the elderly; however the difference was not statistically significant. Dyslipidemia and cigarette smoking were both significantly less common among elderly patients (p<0.05). The elderly were significantly less frequently revascularized (p<0.05). Both fibrinolysis and primary percutaneous coronary intervention (PCI) were less commonly applied to the elderly (p<0.05). Time from symptom onset to hospital admission was significantly longer in the case of elderly patients (p<0.05). The MI complications and side effects of treatment seemed to be more frequent in the elderly, but only post-MI heart failure was observed more frequently in this group of patients (p<0.05).In the elderly, as compared with younger subjects, dyspnea, fatigue, and other heart failure symptoms, were more frequently the first symptoms of MI than typical chest pain (p<0.05). ST-segment elevation myocardial infarction (STEMI) was also more common (p<0.05). Non-ST-segment elevation myocardial infarction (NSTEMI) was more frequently diagnosed in the elderly (p<0.05). In elderly patients there were more women (p<0.05), more patients with previously diagnosed ischemic heart disease (p<0.05), with hypertension (p<0.05), and with diabetes mellitus (p<0.05). Obesity was less frequently diagnosed in the elderly; however the difference was not statistically significant. Dyslipidemia and cigarette smoking were both significantly less common among elderly patients (p<0.05). The elderly were significantly less frequently revascularized (p<0.05). Both fibrinolysis and primary percutaneous coronary intervention (PCI) were less commonly applied to the elderly (p<0.05). Time from symptom onset to hospital admission was significantly longer in the case of elderly patients (p<0.05). The MI complications and side effects of treatment seemed to be more frequent in the elderly, but only post-MI heart failure was observed more frequently in this group of patients (p<0.05).ConclusionsOur observations confirm the differences in the clinical picture of MI in the elderly as described previously. All patients of advanced age should be considered as having the highest risk of death and complications occurrence. Copyright © 2009 Wiley Periodicals, Inc.Our observations confirm the differences in the clinical picture of MI in the elderly as described previously. All patients of advanced age should be considered as having the highest risk of death and complications occurrence. Copyright © 2009 Wiley Periodicals, Inc.
Arquivos Brasileiros de Cardiologia, 2002
To study the in-hospital evolution of patients aged 65 years and older, with acute myocardial infarction, who were treated by direct coronary angioplasty with no fibrinolytic therapy. Methods-We studied 885 patients divided into 2 groups as follows: group I (GI)-293 (33.4%) patients aged ≥ 65 years (72±5 years), and group II (GII)-592 patients aged < 65 years (57±9 years). Multivessel disease was more frequent in GI (63.5% x 49.7%; p=0.001). A greater number of GII patients were class I or II of the clinical Killip-Kimball classification (K) (80.2% x 67.2%; p=0.00002), while a significant number of GI patients were KIII and KIV (24.3% x 12.8%; p=0.00003). Results-Group I had a lower index of success (84.6% x 94%; p=0.0002) and a greater in-hospital mortality (12.2% x 4.7%; p=0.00007). The predictors of mortality in GI were as follows: previous infarction (20.5% x 6.3%; p=0.02), anterior location (13.4% x 6.4%; p=0.03), and male sex (10.4% x 4.4%; p=0.007). Conclusion-Elderly patients had more severe acute myocardial infarction and more extensive disease, a lower index of success, and greater in-hospital mortality. Previous infarction, anterior location and male sex were identified as predictors of mortality in the elderly group (GI).
Revista Española de Cardiología, 2015
In the present article, we review publications from the previous year in the following 3 areas: clinical cardiology, geriatric cardiology, and heart failure and transplantation. Among the new developments in clinical cardiology are several contributions from Spanish groups on tricuspid and aortic regurgitation, developments in atrial fibrillation, syncope, and the clinical characteristics of heart disease, as well as various studies on familial heart disease and chronic ischemic heart disease. In geriatric cardiology, the most relevant studies published in 2014 involve heart failure, degenerative aortic stenosis, and data on atrial fibrillation in the geriatric population. In heart failure and transplantation, the most noteworthy developments concern the importance of multidisciplinary units and patients with preserved systolic function. Other notable publications were those related to iron deficiency, new drugs, and new devices and biomarkers. Finally, we review studies on acute heart failure and transplantation, such as inotropic drugs and ventricular assist devices.
European Journal of Epidemiology, 2000
Background and objectives: The myocardial infarction (MI) incidence rate, prognosis and hospitalisation rate in the population 65 and over are rarely studied. We sought to determine MI hospitalisation and incidence rates, and 28-day case-fatality, in the 65 year and older population, and to analyse whether their management and prognosis differed from that of younger patients. Methods: All residents in Gerona (Spain) older than 24 years with suspected fatal or non-fatal MI were investigated and included in a population registry. Results: MI mortality, incidence, and case-fatality dramatically increased with age after 64. Smoking, thrombolysis, antiplatelet and betablocker drug use, coronary angiograms, and coronary revascularisation decreased with age. The risk of death of patients between 75 and 84 years (OR: 4.15, 95% confidence interval, CI: 1.70-10.15) and between 85 and 94 years (OR: 4.68, 95% CI: 1.62-13.52) was higher than in the 34-64 years age group, independently of any patient characteristic. Conclusions: The magnitude of the impact of MI in the elderly at population and hospital levels is substantially higher than in those younger than 65 years of age. After this age patients receive less treatments and procedures than their younger counterparts.
Comparison of Patients with Acute Myocardial Infarction According to Age
Medicinski arhiv, 2019
Introduction: By development of the medicine, control of the risk factors for acute myocardial infarction (AMI), became the foundation of cardiology. Aim: To investigate the association of the age with presence of risk factors in patients with acute myocardial infarction. Methods: The study had a prospective, comparative and descriptive character, and it was done on a sample of 80 patients (n=80; 55 male and 25 female) Clinic for Heart, Blood Vessel and Rheumatic Diseases, Clinical Center University of Sarajevo from January 2016 to August 2018. All patients were hospitalized under the diagnosis of myocardial infarction and were divided into two main groups, which were divided into two subgroups according to age. Group A, group of patients under 45 years of age at the moment of diagnosis of AMI (n = 40; men = 29; women = 11) was divided into group A1 (n = 20; patients aged 25-35 years) and group A2 (n = 20; patients aged between 35-45 years). Group B, patients older than 45 years at the time of diagnosis of AMI (n = 40; men = 26, women = 14) was divided into group B1 (n = 20; patients aged between 45-55 years) and group B2 (n = 20; patients aged 55-65 years of age). Results: According to gender distribution, there is a significantly higher incidence of hypertension in male patients aged 25-35 years and between 35-45 years (p = 0.01; p = 0.01). Increased cholesterol values were significantly more common in men aged 25-35 years (p = 0.0121). Increased triglyceride values were significantly more common in men aged 25-35 years, in comparison to female respondents of the same age (86.67% vs. 13.33%, p = 0.0001). There was a significant significance between the two groups in the occurrence of anteroseptal (p = 0.04) and in the diaphragmatic myocardial infarction (p = 0.01), while in other infarction localities no significant significance was observed. Conclusion: Male sex is a predisposing risk factor for the development of a cardiovascular incident in the younger age. The post infarction ejection fraction of the left ventricle was significantly reduced in younger patients. The potential for prevention should be of paramount importance. The localization of the incident itself, and the involvement of a certain blood, represents, regardless of all the research, still a fact that is hard to stratify and directly correlated with a certain risk factor.
Myocardial infarction in the elderly
2011
Advances in pharmacological treatment and effective early myocardial revascularization have-in recent years-led to improved clinical outcomes in patients with acute myocardial infarction (AMI). However, it has been suggested that compared to younger subjects, elderly AMI patients are less likely to receive evidence-based treatment, including myocardial revascularization therapy. Several reasons have been postulated to explain this trend, including uncertainty regarding the true benefits of the interventions commonly used in this setting as well as increased risk mainly associated with comorbidities. The diagnosis, management, and post-hospitalization care of elderly patients presenting with an acute coronary syndrome pose many difficulties at present. A complex interplay of variables such as comorbidities, functional and socioeconomic status, side effects associated with multiple drug administration, and individual biologic variability, all contribute to creating a complex clinical scenario. In this complex setting, clinicians are often required to extrapolate evidence-based results obtained in cardiovascular trials from which older patients are often, implicitly or explicitly, excluded. This article reviews current recommendations regarding management of AMI in the elderly.
Clinical profile of acute myocardial infarction in elderly patients
Journal of Cardiovascular Disease Research, 2013
The aim of study was to determine the difference in presentation, risk factors, complications, management and outcome of elderly and young patients with acute myocardial infarction (AMI). Settings and design: Tertiary care center; prospective observational study. Materials and method: The study included 200 consecutive patients with AMI admitted in the ICCU, in a tertiary care center in West India. The group I consisted of 107 patients aged equal to or above 65 years and the group II consisted of 93 patients aged below 65 years. Statistical analysis: Two tailed student's t test and Chi-square statistics (Fisher's test) for P value. Results: The male female ratio was 1.27:1 and 3.43:1 in group I and group II respectively. Atypical presentations were more likely in the elderly, with shortness of breath as the most common presentation (40.18% versus 15.05%; P < 0.05. Risk factors like hypertension, dyslipidemia and diabetes were equally present in both groups but obesity, smoking and family history of coronary artery disease was more prevalent in younger age group (P < 0.05). The elderly were significantly less frequently revascularized (P < 0.05). Time from symptom onset to hospital admission was significantly longer in the case of elderly patients (P < 0.05). The elderly were more likely to have complications of cardiac failure (P < 0.05) and arrhythmias especially atrio-ventricular (AV) blocks. The elderly were also less likely to receive betablockers (P < 0.05). In-hospital mortality was higher in the elderly (P < 0.001). Conclusion: We conclude that the manifestations of AMI are more subtle in the elderly, with different risk factors.
Clinical Manifestation of Acute Myocardial Infarction in the Elderly
Medical Journal of Indonesia, 2003
A retrospective study were performed in patients with acute myocardial infarction (AMI) that hospitalized in ICCU Cipto Mangunkusumo hospital, Jakarta during the period of January 1994 until Decmber 1999. There were 513 patients hospitalized with MCI, 227 patients (44.2%) were classified as elderly, and 35.2% of them were female. Most of the elderly AMI patients reported typical chest pain just like their younger counterparts. Elderly AMI patients tend to come later to the hospital, and more Q-wave myocardial infarction were identified compared to non-Q-wave myocardial infarction. Risk factors of diabetes mellitus and hypertension were more common among the elderly. The prevalence of atrial fibrillation and the mortality rate were higher among elderly AMI patients.