The clinical manifestation of myocardial infarction in elderly patients

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).

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).

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).

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.