title: Do elderly females have a higher risk of acute myocardial infarction? A retrospective analysis of 329 cases at an emergency department.
abstract: OBJECTIVE
  Acute myocardial infarction (AMI) is a medical emergency; a missed or delayed diagnosis of this disease may contribute to a poor outcome and even death. Several studies have found elderly patients with AMI have atypical presentations for diagnosis, therefore we undertook this study to determine the risks among the elderly population, especially in female patients.
  
  
  METHODS
  In this one-year retrospective study, we reviewed the cases of AMI patients who had visited the emergency department at Mackay Memorial Hospital, Taiwan, and who had either been discharged or had died following a diagnosis of AMI (ICD code 410). We compared the differences between the clinical presentations of these two groups as well as the risk factors, medical management, and outcomes.
  
  
  RESULTS
  In our study, only 329 patients (164 elderly; 165 adults) met the defined criteria. The most common symptom of AMI was chest pain, and this was more common in adult patients than in elderly patients (81.8% vs. 60.4%, p < 0.001). In comparison with patients in the adult group, the patients in the elderly group had a significantly higher proportion of females (46.3% vs. 12.7%), non-ST-elevation myocardial infarction (NSTEMI) (71.3% vs. 46.7%), presenting with no chest pain (39.6% vs. 18.2%), shortness of breath (17.7% vs. 8.8%), nausea/vomiting/dizziness (7.9% vs. 2.4%), abdominal pain (4.3% vs. 0.6%), diabetes mellitus (45.1% vs. 26.1%), cerebrovascular disease (22.6% vs. 6.1%), longer hospital stays (18.2 ± 31.0 days vs. 9.8 ± 8.2 days), and increased in-hospital mortality rates (15.9% vs. 6.7%).
  
  
  CONCLUSIONS
  Compared with the adult AMI group, the elderly AMI group had a higher proportion of females, electrocardiography with NSTEMI and no chest-pain complaints, and a larger proportion of elderly patients with diabetes, ischemic heart disease, heart attacks at home and cardiac shock, which had longer hospital stays, and higher mortality rates.
authors: School of Medicine, Mackay Medical College, Taipei, Taiwan; Department of Emergency Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Institute of Mechatronic Engineering, National Taipei University of Technology, Taipei, Taiwan; Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan; College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Medicine, Mackay Memorial College Department of Cardiology, MacKay Memorial Hospital, Taipei, Taiwan.
authors: Ding-Kuo
authors: DK
authors: Chien
authors: School of Medicine, Mackay Medical College, Taipei, Taiwan; Department of Emergency Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
authors: Ming-Yuan
authors: MY
authors: Huang
authors: Department of Rehabilitation, Tai-En Memorial Hospital, Taipei, Taiwan.
authors: Chien-Hsuan
authors: CH
authors: Huang
authors: School of Medicine, Mackay Medical College, Taipei, Taiwan; Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; Department of Medicine, Mackay Memorial College Department of Cardiology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
authors: Shou-Chuan
authors: SC
authors: Shih
authors: School of Medicine, Mackay Medical College, Taipei, Taiwan; Department of Emergency Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Institute of Mechatronic Engineering, National Taipei University of Technology, Taipei, Taiwan; Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan; College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Medicine, Mackay Memorial College Department of Cardiology, MacKay Memorial Hospital, Taipei, Taiwan. Electronic address: branden888@gmail.com.
authors: Wen-Han
authors: WH
authors: Chang
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000209:etiology; D002637:Chest Pain / Q000453:epidemiology / Q000209:etiology; D058065:Diabetic Cardiomyopathies / Q000453:epidemiology / Q000209:etiology; D004244:Dizziness / Q000453:epidemiology / Q000209:etiology; D004417:Dyspnea / Q000453:epidemiology / Q000209:etiology; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality; D009325:Nausea / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012770:Shock, Cardiogenic / Q000453:epidemiology / Q000209:etiology; D063189:Symptom Assessment; D013624:Taiwan; D055815:Young Adult
keywords: acute myocardial infarction; chest pain; elderly; female