[Acute myocardial infarction in the elderly. A case-control study with a younger population and review of literature].
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 > or =75 years, hospitalized in CCU between 1999 and 2003 for STEMI, were evaluated. 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.


CONCLUSIONS
The patients >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.
Corsini
Fabrizio
F
IV Divisione di Medicina Interna, Seconda Universita degli Studi di Napoli. fabrizio.corsini@libero.it
Scaglione
Anna
A
Iacomino
Maria
M
Mascia
Giuseppe
G
Melorio
Saverio
S
Riccio
Carmine
C
Romano
Salvatore
S
Vetrano
Alfredo
A
Celardo
Silvana
S
Corsini
Giancarlo
G
Chieffo
Carmelo
C
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015906:Angioplasty, Balloon, Coronary; D016022:Case-Control Studies; D004562:Electrocardiography; D005069:Evaluation Studies as Topic; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use; D006329:Heart Conduction System / Q000503:physiopathology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis
D005343:Fibrinolytic Agents