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[Acute myocardial infarction in the thrombolytic era: high mortality in elderly patients]
C A Polanczyk1, K Prado, M S Borges
1Serviço de Cardiologia e Centro de Tratamento Intensivo Clínico e Cirúrgico do Hospital de Clínicas de Porto Alegre.
Insights
In-hospital mortality for acute myocardial infarction (AMI) is high in general hospitals, particularly for older patients. Advanced age, not thrombolytic therapy, predicts poor prognosis in these AMI patients.
Area of Science:
- Cardiology
- Internal Medicine
- Public Health
Context:
- Patients with acute myocardial infarction (AMI) admitted to general hospitals differ significantly from those in large multicenter trials.
- Understanding in-hospital mortality patterns in community settings is crucial for improving patient outcomes.
Purpose:
- To evaluate in-hospital mortality in acute myocardial infarction (AMI) patients admitted to a general hospital during the thrombolytic era.
- To identify prognostic factors associated with poor outcomes in this patient population.
Summary:
- A study of 113 consecutive AMI patients revealed a 19.5% in-hospital mortality rate.
- Advanced age was the sole independent predictor of mortality, with patients over 70 experiencing significantly higher mortality (41%) compared to younger patients (8.1%).
- Thrombolytic therapy use did not impact survival, and adverse effects were noted in a significant proportion of treated patients.
Impact:
- The findings highlight that advanced age is a primary driver of high in-hospital mortality following AMI in general hospitals.
- Despite therapeutic advancements, older AMI patients do not appear to benefit as much as younger counterparts, indicating a need for age-specific treatment strategies.
Unlabelled:
Patients with acute myocardial infarction (AMI) admitted to a general hospital are very different from those reported in large multicenter trials.
Purpose:
To evaluate the in-hospital mortality in patients with AMI admitted to a general hospital in the thrombolytic era, and to identify factors associated with poor prognosis.
Methods:
113 consecutive patients admitted with AMI in one year at the Hospital de Clínicas of Porto Alegre were studied. Several clinical and laboratory variables related to higher risk were evaluated. According to the hospital routine, 47% of the patients received thrombolytic therapy, and the effects and complications of its use were studied.
Results:
In-hospital mortality was 19.5%. By univariate analysis, age, female gender and peak creatinephosphokinase level were significantly associated with early mortality. By multiple logistic regression analysis, advanced age was the only predictive variable, even after adjusting for other baseline risk factors. In patients older than 70 years, in-hospital mortality was 41% versus only 8.1% in the younger group. There was no difference in survival with the presence of others factors such as previous myocardial infarction, use of thrombolytic therapy, heart failure, infarcted area, diabetes, and systemic hypertension. Among patients who received thrombolytic therapy, an elevated number of adverse effects was observed, and in 9.4% of the cases the complications were serious.
Conclusion:
The high in-hospital mortality after AMI in a general hospital is associated with the patients' advanced age. In spite of recent therapeutic advances in the treatment of AMI, older patients have not obtained a comparable benefit as that achieved by the younger group.