[Acute myocardial infarction in elderly patients]
Nadhem Hajlaoui1, Hedi Ellefi, Badii Jdaida
1Service de Cardiologie, Hopital militaire, Tunis, Tunisie.
Insights
Elderly patients with acute myocardial infarction (AMI) benefit from reperfusion therapies like fibrinolysis and primary PCI, showing improved outcomes. Invasive treatments are associated with better results in the acute phase and at 12 months.
Area of Science:
- Cardiology
- Geriatric Medicine
- Epidemiology
Context:
- Age is a critical factor influencing outcomes in acute coronary syndromes (ACS).
- Ischemic heart disease is a leading cause of mortality in the elderly population.
- Understanding the specific challenges in elderly patients with AMI is crucial for effective treatment.
Purpose:
- To investigate the epidemiological characteristics of Acute Myocardial Infarction (AMI) in patients over 65 years.
- To describe the clinical presentation and treatment patterns in this demographic.
- To evaluate the outcomes of elderly patients with AMI during hospitalization and at one-year follow-up.
Summary:
- A study of 100 patients over 65 with AMI revealed a mean age of 77. STEMI was prevalent (65%), with significant rates of heart failure (40%) and cardiogenic shock (10%) on admission.
- Only 44% arrived within 12 hours. Reperfusion therapy (fibrinolysis or primary PCI) was administered to 58%, correlating with better outcomes.
- Older patients (>75 years) experienced higher rates of adverse events, including heart failure, shock, and mortality.
Impact:
- Invasive treatments, including fibrinolysis and percutaneous coronary intervention (PCI), demonstrate a significant association with improved outcomes in elderly patients with AMI.
- Early reperfusion therapy in elderly patients with AMI is linked to better in-hospital and long-term results.
- Findings highlight the importance of considering age-specific strategies for managing acute myocardial infarction in geriatric populations.
Background:
Age is the most important determinant of outcome for patients with acute coronary syndromes (ACS) and ischemic heart disease is the leading cause of death among elderly patients.
Aim:
To determine the epidemiologic particularities, the clinical presentation, and the treatment of Acute Myocardial Infarction (AMI) in patients over 65 years.
Methods:
One hundred patients >65 years of age with myocardial infarction were hospitalized in intensive care of cardiologic unit of Military Hospital of Tunis between 2000 and 2008. Clinical characteristics, reperfusion therapy and outcomes of in-hospital period and for one year follow-up were seen for every patient.
Results:
The mean age of our population was 77 years. Sex-ratio was 3/1.Our population was divided into tow groups; patients aged between 65 and 75 years (48 patients) and those aged more than 75 years (52 patients). Only 44 % of our patients had arrived at the hospital within the first 12 hours. STEMI was found in 65 % of our patients. At admission, 40 % had congestive heart failure (³ Killip II), 10 % were in cardiogenic shock. Urgent reperfusion therapy was given to 58 % of our patients; 33% received a thrombolytic therapy and 25 % were allocated to primary PCI. During in-hospital period, 40 % have developed congestive heart failure, 20 % have had a cardiogenic shock and 12 % were died. All these events were more frequent in patients aged over 75 years and reperfusion therapy was associated with best outcome.
Conclusion:
In our study invasive treatment such as fibrinolysis and PCI was associated to better outcome in acute period and at 12 months of follow up in elderly patients treated for AMI.
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