Factors Affecting the Management of Outcome in Elderly Patients with Acute Myocardial Infarction Particularly with Regard to Reperfusion

Abstract

Background: Acute myocardial infarction (AMI) in elderly patients is often unrecognized and associated with poor prognosis. Objectives: To investigate management and efficacy of reperfusion therapy to the elderly patients with AMI. Methods: From the January 1, 2001 to October 31, 2002, 964 patients with AMI were included in the French regional RICO survey. The patients were divided into three groups: younger (<70 years old), elderly (70–79 years old) and very elderly (≧80 years old). Results: Distribution of groups was 56, 27, and 16%, respectively. The longest time delay to first request for medical attention was found in the very elderly group (30 and 55 vs. 90 min, respectively, p < 0.05). Rate of lysis fell significantly with increasing age (35, 22 and 9%, respectively, p < 0.001) but the time delay to lysis was similar for the 3 groups. The proportion of patients who benefited from primary percutaneaous transluminal coronary angioplasty decreased with age (21, 15, 11%, respectively, p < 0.001), but time delay to balloon angioplasty was similar and no difference in mortality rate was observed between the three groups after reperfusion. The incidence of in-hospital cardiovascular events (cardiogenic shock and recurrent myocardial infarction/ischemia) and in-hospital mortality increased with age (5, 13, 17%, respectively, p < 0.001). Moreover, multivariate analysis showed that only ejection fraction and Killip >1 were independent predictive factors for in-hospital cardiovascular mortality, respectively (OR 5.15, 95% CI 2.08–12.74, p < 0.0001 and OR 3.81, 95% CI 1.90–7.65, p < 0.0001), whereas age, sex, diabetes and anterior location were not significant. Conclusion: Our data in an unselected population indicate that very elderly patients were characterized by increased pre-hospital delays and less frequent utilization of reperfusion therapy, although no difference in the mortality in reperfused patients could be observed between the three age groups.

Old Age and Outcome After Primary Angioplasty for Acute Myocardial Infarction

“…Whereas older people are often not considered to be candidates for invasive reperfusion therapy, this may be the treatment of choice in this patient category, because the benefits seem to be the greatest 2,4–8 . Over the last decade, the number of older patients (≥75) treated and referred for primary angioplasty has increased considerably, and this trend has also been observed in other registries 13,16 . In the current study, patients younger than 65 had a low 30‐day risk of mortality after primary angioplasty (2.7%), but this increased to 5.2% in patients aged 65 to 74 and reached 12.6% in those aged 75 and older ( P =.001).…”

“…Many factors influencing this process have been suggested, among them high incidence of comorbidity, high risk of bleeding during and after intervention, healthcare costs, and a general fear of complications after an intervention in older people. In addition, the symptomatology of myocardial infarction, including pain and nonpain symptoms, in elderly patients is less specific than in younger patients 13,14 . A randomized comparison of fibrinolytic therapy and primary PCI in elderly patients (≥75) with AMI was previously reported and suggested a better outcome after the latter reperfusion mode 8 .…”

Prognostic Value of Tissue Doppler Echocardiographic Imaging in Elderly Patients with Acute Myocardial Infarction

“…The data about predictive value of echocardiography in patients above 65 years of age with myocardial infarction are limited. In a large group of elderly patients with acute myocardial infarction, only EF and Killip class above I were the independent factors of in‐hospital mortality, opposite to sex, age, diabetes and anterior location of necrosis 17 . In a group of 142 patients mean age 80 years, with acute coronary syndrome, echocardiographic LV EF less than 40% and restrictive diastolic filling pattern predicted 2‐year survival 18 .…”

“…In a large group of elderly patients with acute myocardial infarction, only EF and Killip class above I were the independent factors of in-hospital mortality, opposite to sex, age, diabetes and anterior location of necrosis. 17 In a group of 142 patients mean age 80 years, with acute coronary syndrome, echocardiographic LV EF less than 40% and restrictive diastolic filling pattern predicted 2-year survival. 18 In our group of patients EF was also proved to be an independent determinant of mortality.…”

Clinical manifestations and effects of primary percutaneous coronary intervention for patients with delayed pre-hospital time in acute myocardial infarction

“…However, these efforts are weakened by patient delay, which is said to account for almost two thirds of the time from the onset of symptoms to treatment. Many reports have shown that various factors such as age [15], gender [16], pre-infarction angina [17], and cognitive and emotional factors including the patient's beliefs about causes [18,19] were associated with patient delay. Our data suggest that factors such as advanced age, female sex, and DM are associated with patient delays.…”