title: Risk profile and in-hospital prognosis in elderly patients presenting for acute ST-elevation myocardial infarction in the Tunisian context.
abstract: OBJECTIVE
  Little is known about the risk profile and in-hospital prognosis of elderly patients presenting for ST-elevation myocardial infarction (STEMI) in Tunisia. We sought to determine in-hospital prognosis of elderly patients with STEMI in a Tunisian center.
  
  
  METHODS
  The study was carried out on a retrospective registry enrolling 1403 patients presenting with STEMI in a Tunisian center between January 1998 and January 2013. Patients ≥75 years old were considered elderly. Risk factors and in-hospital prognosis were compared between elderly and younger patients, and then predictive factors of in-hospital death were determined in elderly patients.
  
  
  RESULTS
  Out of the overall population, 211 (15%) were part of the elderly group. Compared to younger patients, elderly patients were more likely to have arterial hypertension but less likely to be smokers and obese. Thrombolysis was significantly less utilized in the elderly group (22.3% vs. 36.6% in the younger group, p<0.001), whereas the use primary percutaneous coronary intervention was comparable between the two sub-groups (24.2% vs. 28.8%, p=0.17). The incidence of in-hospital complications was higher in the elderly group, and so was the in-hospital mortality rate (14.2% vs. 8.1%, p=0.005). Heart failure on-admission, renal failure on-admission, and inotropic agents use were independently associated to in-hospital death in the elderly group.
  
  
  CONCLUSIONS
  In the Tunisian context, elderly patients presenting with STEMI have higher prevalence of risk factors and a worse in-hospital course in comparison to younger patients. Clinical presentation on-admission has a strong impact on in-hospital prognosis.
authors.affiliation: Cardiology B Department, Fattouma Bourguiba University Hospital and University of Monastir, Monastir, Tunisia. Electronic address: jomaa_w@hotmail.fr.
authors.forename: Walid
authors.initials: W
authors.lastname: Jomaa
authors.affiliation: Cardiology B Department, Fattouma Bourguiba University Hospital and University of Monastir, Monastir, Tunisia.
authors.forename: Sonia
authors.initials: S
authors.lastname: Hamdi
authors.affiliation: Cardiology B Department, Fattouma Bourguiba University Hospital and University of Monastir, Monastir, Tunisia.
authors.forename: Imen
authors.initials: I
authors.lastname: Ben Ali
authors.affiliation: Cardiology B Department, Fattouma Bourguiba University Hospital and University of Monastir, Monastir, Tunisia.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Azaiez
authors.affiliation: Cardiology B Department, Fattouma Bourguiba University Hospital and University of Monastir, Monastir, Tunisia.
authors.forename: Aymen
authors.initials: A
authors.lastname: El Hraiech
authors.affiliation: Cardiology B Department, Fattouma Bourguiba University Hospital and University of Monastir, Monastir, Tunisia.
authors.forename: Khaldoun
authors.initials: K
authors.lastname: Ben Hamda
authors.affiliation: Cardiology B Department, Fattouma Bourguiba University Hospital and University of Monastir, Monastir, Tunisia.
authors.forename: Faouzi
authors.initials: F
authors.lastname: Maatouk
mesh_terms: D000367:Age Factors; D000368:Aged; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D014416:Tunisia / Q000453:epidemiology
keywords: Elderly; Mortality; Risk factor; ST-elevation myocardial infarction