[Acute myocardial infarction in the thrombolytic era: high mortality in elderly patients].
Patients with acute myocardial infarction (AMI) admitted to a general hospital are very different from those reported in large multicenter trials.


OBJECTIVE
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.


CONCLUSIONS
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.
Polanczyk
C A
CA
Serviço de Cardiologia e Centro de Tratamento Intensivo Clínico e Cirúrgico do Hospital de Clínicas de Porto Alegre.
Prado
K
K
Borges
M S
MS
Ribeiro
J P
JP
D000328:Adult; D000367:Age Factors; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015912:Thrombolytic Therapy
D005343:Fibrinolytic Agents
Infarto agudo do miocárdio na era trombolítica: elevada mortalidade em pacientes idosos.