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

https://doi.org/10.4081/monaldi.2006.537

Authors

  • Fabrizio Corsini | fabrizio.corsini@libero.it IV Divisione di Medicina Interna - Seconda Università degli Studi di Napoli, Italy.
  • Anna Scaglione Cattedra di Geriatria del Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche - Università Federico II di Napoli, Italy.
  • Maria Iacomino Dipartimento di Scienze Cardiologiche. Azienda Ospedaliera “San Sebastiano” di Caserta, Italy.
  • Giuseppe Mascia Dipartimento di Scienze Cardiologiche. Azienda Ospedaliera “San Sebastiano” di Caserta, Italy.
  • Saverio Melorio Dipartimento di Scienze Cardiologiche. Azienda Ospedaliera “San Sebastiano” di Caserta, Italy.
  • Carmine Riccio Dipartimento di Scienze Cardiologiche. Azienda Ospedaliera “San Sebastiano” di Caserta, Italy.
  • Salvatore Romano Dipartimento di Scienze Cardiologiche. Azienda Ospedaliera “San Sebastiano” di Caserta, Italy.
  • Alfredo Vetrano Dipartimento di Scienze Cardiologiche. Azienda Ospedaliera “San Sebastiano” di Caserta, Italy.
  • Silvana Celardo Dipartimento di Scienze Cardiologiche. Azienda Ospedaliera “San Sebastiano” di Caserta, Italy.
  • Giancarlo Corsini Dipartimento di Scienze Cardiologiche. Azienda Ospedaliera “San Sebastiano” di Caserta, Italy.
  • Carmelo Chieffo Dipartimento di Scienze Cardiologiche. Azienda Ospedaliera “San Sebastiano” di Caserta, Italy.

Abstract

Background: ST elevation myocardial infarction (STEMI) in old and old-old patients presents several peculiarities in natural history, delay of hospitalization and response to treatment. Aim of this retrospective case control study was to determine presentation, complications and management of elderly patients with STEMI compared to a younger population. Methods: 462 patients (205 M and 257 F) aged ≥75 years, hospitalized in CCU between 1999 and 2003 for STEMI, were valuated. The control group consisted of 490 consecutive patients (268 M and 222 F) aged 50-70 years. Attention was focused on clinical presentation, complications, management and outcome in elderly compared with younger patients. 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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Published
2016-02-05
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Section
Original Articles
Keywords:
myocardial infarction, elderly, thrombolysis, PTCA
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How to Cite
Corsini, Fabrizio, Anna Scaglione, Maria Iacomino, Giuseppe Mascia, Saverio Melorio, Carmine Riccio, Salvatore Romano, Alfredo Vetrano, Silvana Celardo, Giancarlo Corsini, and Carmelo Chieffo. 2016. “Acute Myocardial Infarction in the Elderly. A Case-Control Study With a Younger Population and Review of Literature”. Monaldi Archives for Chest Disease 66 (1). https://doi.org/10.4081/monaldi.2006.537.

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