title: Significance of atypical symptoms for the diagnosis and management of myocardial infarction in elderly patients admitted to emergency departments.
abstract: BACKGROUND
  Few recent studies have examined the characteristics of ST-segment elevation myocardial infarction (STEMI) among elderly patients managed in emergency departments (EDs).
  
  
  OBJECTIVE
  To describe the clinical characteristics and management of elderly STEMI patients in EDs.
  
  
  METHODS
  This retrospective, multicentre study involved STEMI patients aged ≥ 75 years admitted to four different EDs in the city of Lyon between 2004 and 2008.
  
  
  RESULTS
  Among 255 patients, reasons for admission to the ED included chest pain (41.2%), faintness and/or fall (15.7%), dyspnoea (15.7%), digestive symptoms (9.8%), impaired general condition (6.7%) and delirium (5.0%). Compared with those who presented with chest pain, patients admitted for other reasons waited longer before going to the hospital (prehospital delay< 12 hours: 32.0% vs 73.3%; P<0.001), presented with more severe clinical symptoms (Killip score≥III: 28.0% vs 10.5%; P=0.001), waited longer to be examined in the hospital (waiting time > 1 hour: 36.0% vs 11.4%; P<0.001), were less likely to receive reperfusion therapy (40.7% vs 77.1%; P<0.001) and had a higher mortality rate at 1 month (42.7% vs 21.0%; P<0.001). Such atypical symptoms are more common among patients with cognitive impairment and/or communication difficulties.
  
  
  CONCLUSIONS
  Atypical clinical symptoms of STEMI are common and severe among elderly patients in EDs. Thus, rapid provision of an electrocardiogram to all elderly patients admitted to the ED is essential, even in the absence of cardiovascular symptoms.
authors.affiliation: Service de Gériatrie, Hôpital du Dr-Frédéric-Dugoujon, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France. Electronic address: pierre.grosmaitre@gmail.com.
authors.forename: Pierre
authors.initials: P
authors.lastname: Grosmaitre
authors.forename: Olivier
authors.initials: O
authors.lastname: Le Vavasseur
authors.forename: Estelle
authors.initials: E
authors.lastname: Yachouh
authors.forename: Yves
authors.initials: Y
authors.lastname: Courtial
authors.forename: Xavier
authors.initials: X
authors.lastname: Jacob
authors.forename: Sylvie
authors.initials: S
authors.lastname: Meyran
authors.forename: Pierre
authors.initials: P
authors.lastname: Lantelme
mesh_terms: D000058:Accidental Falls; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000209:etiology; D003693:Delirium / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D005602:France; D005767:Gastrointestinal Diseases / Q000209:etiology; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion; D010343:Patient Admission; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013575:Syncope / Q000209:etiology; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: ACS; Acute coronary syndromes; Clinical presentation; ECG; ED; Elderly patients; Emergency department; GRACE; Global Registry of Acute Coronary Events; NRMI; National Registry of Myocardial Infarction; Présentation clinique; SD; SEGA; ST-segment elevation myocardial infarction; STEMI; Service d’urgence; Short Emergency Geriatric Assessment; Sujet âgé; Syndrome coronarien aigu; Syndrome coronarien aigu avec sus-décalage du segment ST+; acute coronary syndromes; electrocardiogram; emergency department; standard deviation