Geriatric patients with acute myocardial infarction: Cardiac risk factor profiles, presentation, thrombolysis, coronary interventions, and prognosis

Elderly patients have a higher mortality after acute myocardial infarction (MI) yet are treated less aggressively than younger patients, To determine (1) the risk-factor profiles, (2) presentation, (3) management, and (4) hospital outcomes for the elderly (greater than or equal to 75 years) compared with middle aged (66 to 74 years) and younger (less than or equal to 65 years) patients in the 1990s, we studied 561 consecutive patients with acute MI, Compared with younger patients, the elderly more frequently had congestive heart failure (40% vs 14%; p < 0.00001) and non-Q wave infarctions (76% vs 56%; p < 0.005), received thrombolysis (9% vs 34%; p < 0.0001), and underwent catheterization (35% vs 73%; p < 0.00001), percutaneous transluminal coronary angioplasty (9% vs 31%; p < 0.0002), and coronary artery bypass grafting (5% vs 15%; p < 0.03) less frequently, Those who did not receive thrombolysis all had contraindications, Mortality was higher in the elderly (19% vs 5%; p < 0.004), especially among those who did not receive thrombolysis (20% vs 7%; p < 0.03), Multivariate predictors of mortality included age, and congestive heart failure, In addition, when clinical course and management variables were considered, use of the intraaortic balloon pump was a predictor of mortality, whereas undergoing coronary angiography was a negative predictor (relative risk, 0.3; 95% confidence intervals, 0.1 to 0.6).