title: Factors affecting the management of outcome in elderly patients with acute myocardial infarction particularly with regard to reperfusion. Data from the French regional RICO survey.
abstract: BACKGROUND
  Acute myocardial infarction (AMI) in elderly patients is often unrecognized and associated with poor prognosis.
  
  
  OBJECTIVE
  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 (>or=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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Service de Gériatrie, CHU Bocage, Dijon, France.
authors.forename: Laura
authors.initials: L
authors.lastname: Popitean
authors.forename: Olivier
authors.initials: O
authors.lastname: Barthez
authors.forename: Gilles
authors.initials: G
authors.lastname: Rioufol
authors.forename: Marianne
authors.initials: M
authors.lastname: Zeller
authors.forename: Isabelle
authors.initials: I
authors.lastname: Arveux
authors.forename: Gilles
authors.initials: G
authors.lastname: Dentan
authors.forename: Yves
authors.initials: Y
authors.lastname: Laurent
authors.forename: Luc
authors.initials: L
authors.lastname: Janin-Manificat
authors.forename: Michel
authors.initials: M
authors.lastname: Fraison
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Beer
authors.forename: Hamid
authors.initials: H
authors.lastname: Makki
authors.forename: Pierre
authors.initials: P
authors.lastname: Pfitzenmeyer
authors.forename: Yves
authors.initials: Y
authors.lastname: Cottin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003625:Data Collection; D003627:Data Interpretation, Statistical; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000706:statistics & numerical data; D012307:Risk Factors; D016896:Treatment Outcome