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.
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.
Popitean
Laura
L
Service de Gériatrie, CHU Bocage, Dijon, France.
Barthez
Olivier
O
Rioufol
Gilles
G
Zeller
Marianne
M
Arveux
Isabelle
I
Dentan
Gilles
G
Laurent
Yves
Y
Janin-Manificat
Luc
L
Fraison
Michel
M
Beer
Jean-Claude
JC
Makki
Hamid
H
Pfitzenmeyer
Pierre
P
Cottin
Yves
Y
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