Acute myocardial infarction in elderly patients: comparative analysis of the predictors of mortality. The elderly versus the young

Leal, Marisa; Filho, Newton Fernando Stadler de Souza; Filho, Hermínio Haggi; Klosoviski, Estela Regina; Munhoz, Eva Cantalejo

doi:10.1590/s0066-782x2002001300004

Cited by 8 publications

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“…As shown earlier and confirmed in our study, elderly patients with STEMI were more often female [2,16], with higher rate of mortality in men [21]. Regarding comorbidities, only chronic renal failure significantly correlated with in-hospital mortality in our patients, also consistent with previous studies [3,22].…”

Section: Discussionsupporting

confidence: 92%

“…Regarding comorbidities, only chronic renal failure significantly correlated with in-hospital mortality in our patients, also consistent with previous studies [3,22]. Congestive heart failure is more frequently in older population with IM [16,20,23], and appeared to be an important predictor of poor outcome [7,22] regardless of appropriate therapeutic approach [7], and more elderly patients with STEMI had higher Killip class > 1, including cardiogenic shock, compared to younger patients [16,21,24]. Widimsky at al [25] compare importance of Killip class on the outcome after PPCI in relation to the age of patients, and found that in-hospital mortality of Killip IV patients was 69% (elderly group), 54% (65-74 years, p < 0.001) and 27% (< 65 years, p < 0.001).…”

Section: Discussionsupporting

confidence: 89%

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Clinical characteristic and management of elderly patients with myocardial infarction

et al. 2019

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Introduction/Objective Population of elderly people is increasing and modern medicine is faced with the problem of large morbidity and mortality from cardiovascular diseases in this age group. Modern treatment strategies have not been sufficiently investigated in the elderly, therefore these people often receive suboptimal treatment. The aim of the study was to evaluate clinical characteristic, cardiac risk factors, management strategies and early outcome in the elderly patient with ST elevated myocardial infarction (STEMI). Methods This retrospective study included 217 consecutive patients, aged ≥ 70 years (mean age 77.6 ± 4.9 years, 103 men, 114 women) with STEMI admitted to the Institute of Cardiovascular Diseases of Vojvodina. We have analyzed patients' clinical characteristics, risk factors, left ventricular function and treatment strategies in relation to in-hospital outcome. Results First clinical symptom was chest pain in 209 (96.3%) of patients. On admission, 35 (16.1%) patients were with severe signs of heart failure (Killip class III-IV). Duration of symptom onset to hospital admission was 14.7 ± 28.6 hours. Out of 217 patients, 168 (77.4%) patients received reperfusion treatment, including primary percutaneous coronary ntervention (PPCI) in 164 (75.6%) patients, and fibrinolytic therapy in 4 (1.8%) patients. Hospital mortality was 26.3% (57 patients). PPCI was univariate predictor of lower in-hospital mortality, whereas multivariate predictors of in-hospital mortality were cardiogenic shock (OR 67.095; 95% CI (6.845-657.646); p < 0.001) and low ejection fraction (OR 0.901; 95% CI (0.853-0.963); p = 0.001). Conclusion In elederly patients presenting with STEMI, PPCI was asscoiated with lower mortality, whereas cardiogenic shock and lower ejection fraction were independent predictors of worse prognosis after STEMI.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 89%

Clinical characteristic and management of elderly patients with myocardial infarction

et al. 2019

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“…L'età sempre più avanzata degli infartuati è dovuta da una parte ad una maggiore sensibilizzazione della popolazione alla correzione dei fattori di rischio quali l'ipertensione, la dislipidemia, il diabete, il fumo, la trombofilia, e dall'altra all'efficacia di interventi farmacologici in questi ultimi tempi sempre più mirati alla prevenzione CV; tutto ciò ha indubbiamente indotto una più lenta evoluzione della malattia arteriosclerotica ed un certo ritardo nella comparsa delle sue manifestazioni cliniche, anche se non sempre ha consentito di evitare l'evento acuto. Nella fase acuta dell'infarto la mortalità aumenta in maniera esponenziale con l'avanzare dell'età, analogo andamento si registra anche a distanza dall'evento [2,3].…”

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“…È stato analizzato il paradosso dell'efficacia della trombolisi negli anziani e grandi anziani, in cui gli effetti negativi possono superare i benefici [3][4][5][6][7].…”

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Acute myocardial infarction in the elderly. A case-control study with a younger population and review of literature

Corsini

Scaglione

Iacomino

et al. 2016

Monaldi Arch Chest Dis

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IntroduzioneNegli ultimi decenni la popolazione d'età superiore ai 75 anni è cresciuta in modo rilevante costituendo in Italia nel 2002 circa l'8% di quella globale e, secondo le previsioni dell'Istituto Superiore di Sanità (ISTISAN), raggiungerà il 10% nel 2010. In questa fascia d'età si registra una netta prevalenza di donne rispetto agli uomini.I dati epidemiologici dimostrano che le malattie cardiovascolari costituiscono la principale causa di morte e d'invalidità degli anziani. Infatti la cardiopatia ischemica nelle sue diverse espressioni cliniche, in particolare l'infarto miocardico acuto (IMA), diventa, in entrambi i sessi, sempre più frequente con l'avanzare dell'età. Da notare che, sempre in base ai dati ISTISAN, mentre la malattia coronarica è decisamente più presente nei maschi al di sotto dei 70 anni di età, la sua incidenza si dimostra invece francamente più elevata nelle femmine che hanno superato i 75 anni nei confronti dei maschi coetanei. Vi è evidenza clinica che circa il 20% di maschi e femmine, all'età di 80 anni, abbia malattia coronarica. Negli Stati Uniti circa il 60% di tutti i pazienti ospedalizzati per IMA, sono ultrasessantacinquenni.L'infarto miocardico acuto nell'ultrasettantacinquenne. Studio caso-controllo con una popolazione più giovane e rassegna della letteratura Results: The mean interval between the onset of symptoms and the arrive in CCU was of 9 hour in the elderly compared to 4,5 hour in the control. Chest pain was less frequent (50% vs 90%) in the elderly; the prevalence of dyspnoea and neurological symptoms was higher in patients >75 years (30% vs 15% and 25% vs 10%). In the elderly, previous angina and AMI, cerebral and peripheral vascular diseases, peripheral and renal failure were frequent. Early severe complications prevailed in the elderly. Thrombolysis was performed only in 39% of the elderly compared to 65% of the control. Significantly higher was cerebral haemorrhage after thrombolysis (4,9% vs 1,8%). Comparable were the mayor extra cranial bleedings. Primary or facilitated PTCA was performed in few patients in the last year. Two weeks mortality was 20%, compared to 6,5% in the control group.Conclusion: The patientes >75 years with STEMI were hospitalized later, had atypical presentation with less chest pain and more cardiac failure, were less likely to receive thrombolysis, had more complications and more cerebral bleedings. Elderly had more associated diseases and in-hospital mortality was higher.

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Estimating the Economic Burden of Acute Myocardial Infarction in the US: 12 Year National Data

Bishu

Lekoubou

Kirkland

et al. 2020

The American Journal of the Medical Sciences

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Acute myocardial infarction in elderly patients: comparative analysis of the predictors of mortality. The elderly versus the young

Abstract: Elderly patients had more severe acute myocardial infarction and more extensive disease, a lower index of success, and greater in-hospital mortality. Previous infarction, anterior location and male sex were identified as predictors of mortality in the elderly group (GI).

Cited by 8 publications

References 25 publications

Clinical characteristic and management of elderly patients with myocardial infarction

Clinical characteristic and management of elderly patients with myocardial infarction

Acute myocardial infarction in the elderly. A case-control study with a younger population and review of literature

Estimating the Economic Burden of Acute Myocardial Infarction in the US: 12 Year National Data

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