[The effect of age on early and late mortality after an acute myocardial infarct]

The purpose of this study is to define the importance of age as predictor of early and late mortality following acute myocardial infarction (AMI). At the same time, effects coming from the use of various therapeutic approaches are considered. We have studied 341 patients, 188 aged < 70 years and 153 > or = 70 years, consecutively admitted to the coronary care unit with diagnosis of AMI. Our findings show that age > or = 70 years, female gender, cardiogenic shock, ventricular fibrillation and early post-infarction angina are significantly connected to higher intra-hospital mortality. As for predictors of 1-year mortality, they turned out to be the age > or = 70 years, indirect signs of more extensive infarction as previous necrosis, acute heart failure, cardiogenic shock, new bundle branch blocks and pre-discharging lower ventricular ejection fraction. In patients aged > or = 70 years, especially in ultra eighty-year old men, thrombolysis, heparin, beta-blockers and aspirin are significantly less employed. All drugs used in the early hours of AMI turned out to be bound to beneficial effects with reduced mortality, except diuretics and antiarrhythmics. The only drugs correlated with an improved 1 year survival are betablockers, aspirin and thrombolysis. On the contrary, the use of diuretics and digoxin is limited to patients with a greater clinical dysfunction. These drugs are associated to a higher late mortality. The present study confirms the finding that elderly patients with AMI who are submitted to less aggressive therapeutic approaches and are more frequently represented by women, have a higher mortality.