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Acute myocardial infarction: contemporary risk and management in older versus younger patients
T Montague1, R Wong, R Crowell
1Division of Cardiology, University of Alberta, Edmonton.
Insights
Older patients (≥70 years) with acute myocardial infarction faced higher mortality risks and received less advanced care. Age 70 or older, absence of chest pain, and lack of thrombolysis were key mortality predictors.
Area of Science:
- Cardiology
- Geriatric Medicine
- Public Health
Background:
- Acute myocardial infarction (AMI) management and outcomes differ across age groups.
- Elderly patients (≥70 years) often present with atypical symptoms and have distinct risk factor profiles.
- Understanding age-related disparities in AMI care is crucial for improving patient outcomes.
Purpose of the Study:
- To compare the in-hospital management and mortality risk of AMI in elderly patients (≥70 years) versus younger patients (<70 years).
- To identify factors associated with increased mortality risk in AMI patients.
Main Methods:
- Retrospective comparison of 101 patients aged ≥70 years (group 1) with 106 patients aged <70 years (group 2) with AMI.
- Analysis of patient demographics, clinical presentation, risk factors, treatment strategies, and in-hospital mortality.
- Logistic regression analysis to determine predictors of mortality.
Main Results:
- Elderly patients had higher rates of previous myocardial infarction (49% vs 25%) and presented without cardiac pain (23% vs 7%).
- Younger patients had more Q-wave infarctions (84% vs 70%) and higher peak creatine kinase levels.
- Less frequent use of post-infarction therapies (thrombolysis, beta-blockers, aspirin) and diagnostic procedures (exercise testing, angiography) in the elderly group.
- In-hospital mortality was significantly higher in the elderly group (35% vs 7%).
- Age ≥70, absence of cardiac pain, and lack of thrombolysis were associated with the greatest mortality risk.
Conclusions:
- Elderly patients with AMI experience significantly higher in-hospital mortality compared to younger individuals.
- Suboptimal management, including reduced utilization of evidence-based therapies and diagnostic procedures, contributes to poorer outcomes in older adults.
- Age, atypical presentation, and treatment delays are critical factors influencing AMI mortality.
Abstract:
The in-hospital management and risk of death of 101 patients 70 years of age or older with acute myocardial infarction in 1987 (group 1) were compared with management and risk for 106 temporally matched patients less than 70 years old (group 2). In group 1, 49% had histories of previous myocardial infarction, compared to 25% in group 2 (P less than 0.001), and 23% of group 1 presented without cardiac pain, versus 7% of group 2 (P less than 0.001). Among the younger patients, other conventional risk factors were, in contrast, more common (Q wave infarction 84% in group 2 versus 70% in group 1; P less than 0.05) or higher (peak creatine kinase values 2222 iu/L in group 2 versus 1366 iu/L in group 1; P less than 0.001). Prior to infarction, all cardiac drugs were used more frequently in the older group 1 patients, whereas post infarction thrombolysis, beta-blockers and acetylsalicylic acid use were all more common (P less than 0.01 to P less than 0.001) in the younger group 2 patients. Post infarction exercise testing, left ventricular ejection fraction calculations and coronary angiography were all performed less frequently in group 1 (P less than 0.001). The in-hospital mortality was 35% for group 1 versus 7% for group 2 (P less than 0.001). Among all 207 study subjects, multiple logistic regression revealed thrombolysis, absence of cardiac pain, and age 70 years or older to be associated with the greatest relative mortality risk. Increased relative risk to a lesser degree was associated with previous infarction, male sex and post infarction use of antiarrhythmic medication.(ABSTRACT TRUNCATED AT 250 WORDS)