Clinical findings, outcome and treatment in patients > or = 75 years with acute myocardial infarction.
OBJECTIVE
Treatment of acute myocardial infarction (AMI) has changed dramatically during the 1990s, and the patients are older. Our aim was to characterize current clinical course, medication and invasive treatment in elderly patients with AMI, compare treatment between sexes and also with data from 1994.


METHODS
The study population included all patients aged > or = 75 years (n = 197, 68% female), who were admitted from January 1997 to December 1998 to our hospital because of AMI.


RESULTS
Sixty-six percent of both sexes had non-Q AMI. Peak creatine kinase (CK)-MB fraction values were significantly higher in men (p = 0.035). Thrombolysis was performed on 16% and coronary angiography, coronary angioplasty/cardiac surgery on 8% of patients each. In-hospital mortality was high (25%). Cholesterol-lowering agents were used for only 8% of patients. During hospitalization, 15% of patients had an infection requiring intravenous antibiotics. Multivariate analysis revealed that infection increased in-hospital mortality 2.90-fold (95% CI: 1.23-6.82) and congestive heart failure (CHF) 2.25-fold (95% CI: 1.02-4.97). Post-discharge mortality was 10% during the median follow-up of 12 months; 75% of deaths were due to re-infarction. Compared with the year 1994, the use of beta-blockers (84 vs. 70%, p = 0.010) and angiotensin-converting enzyme inhibitors (43 vs. 31%, p = 0.062) had increased, and digitalis (27 vs. 43%, p = 0.0065) and calcium antagonists (13 vs. 26%, p = 0.0086) had decreased.


CONCLUSIONS
Treatment and hospital course of AMI in these elderly patients did not differ between sexes. Although drug treatments have become more evidence-based during the end of 1990s, in-hospital mortality was still high and more effective prevention, effective treatment of infections and CHF may be important for improving prognosis.
Kotamäki
Mervi
M
Department of Medicine, Division of Cardiology, University of Helsinki, Finland. mervi.kotamaki@hus.fi
Strandberg
Timo E
TE
Nieminen
Markku S
MS
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005387:Finland / Q000453:epidemiology; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D011014:Pneumonia / Q000150:complications; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D016896:Treatment Outcome