Acute myocardial infarction in the very elderly. A comparison with younger age groups

In a consecutive series of 2312 patients with acute myocardial infarction (AMI) admitted from 1973 till 1979, 188 were 80 years or older (group III). They were compared with 1167 patients younger than 65 years (group I) and 957 aged 65 to 79 years (group II). The sex ratio (males/females) fell from 5.46 in group I to 0.9 in group III. Group III patients had more frequently a history of previous heart failure and more often atypical or no chest pain before admission. Less group III patients were admitted within 4 hours after onset of symptoms, but the incidence of heart failure, pulmonary edema and cardiogenic shock on admission and during CCU stay was definitely higher than in younger patients. Atrial arrhythmias, 2nd and 3rd degree atrioventricular block, complete bundle branch block and intraventricular conduction disturbances occurred more frequently in group III. The electrocardiographic extent and location of the infarction and peak enzyme levels were similar in the three groups. Mortality in group III was 43.6% at the 28th day and 76.6% at one year after AMI. At different intervals after the onset of AMI mortality increased progressively from group I to III. Age by itself, probably on the basis of definite structural changes of the heart and of other organs occurring during aging, leads to higher early and late mortality in very elderly people.