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Determinants of clinical presentation on outcomes in older patients with myocardial infarction

Alice Breining1, Antonin Negers2, Lucie Mora1

  • 1APHP, DHU FAST, Department of Geriatrics, Pitié Salpêtrière - Charles Foix University Hospital, Paris, France.

Geriatrics & Gerontology International
|October 13, 2018
PubMed

Insights

In older patients, multiple comorbidities and nursing home residency increase the risk of atypical myocardial infarction presentation. Identifying these patients can improve prognosis and clinical management.

Area of Science:

  • Geriatric Cardiology
  • Internal Medicine
  • Clinical Gerontology

Background:

  • Myocardial infarction (MI) in elderly patients often presents atypically, lacking chest pain, which can delay diagnosis and increase mortality.
  • Understanding risk factors for atypical MI presentation is crucial for timely intervention in this vulnerable population.

Purpose of the Study:

  • To identify risk factors associated with atypical clinical presentation in patients aged 75 years and older experiencing myocardial infarction.
  • To explore the relationship between comorbidities, geriatric assessments, and the clinical presentation of MI in the elderly.

Main Methods:

  • Prospective, multicenter observational study including 215 consecutive patients aged ≥75 years hospitalized with MI.
  • Patients received specialized cardiac management and geriatric assessment.
  • Analysis focused on identifying predictors of atypical presentation (no chest pain) and 30-day mortality.

Main Results:

  • 34% of elderly MI patients presented atypically (without chest pain).
  • Increased Cumulative Illness Rating Score for Geriatrics and nursing home residency were independent risk factors for atypical MI presentation.
  • Higher Cumulative Illness Rating Score-Geriatric severity index and initial atrial fibrillation predicted 30-day mortality, while typical presentation was protective.

Conclusions:

  • Comorbidities significantly influence both the prognosis and clinical presentation of myocardial infarction in elderly patients.
  • Identifying elderly patients at risk for atypical MI presentation, particularly those with multiple comorbidities, can refine prognostic assessments.
  • Geriatric assessment findings are vital for understanding MI presentation and outcomes in older adults.
Abstract

Keywords:
chest paincomorbiditymortalitymyocardial infarctionolder patients

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