Comparison of risk and patterns of practice in patients older and younger than 70 years with acute myocardial infarction in a two-year period (1987–1989)

To further evaluate contemporary risk and practice patterns in acute myocardial infarction (AMI), 402 consecutive patients with AMI between July 1, 1988, and June 30, 1989 were studied. The clinical investigations, medical therapy and outcome of patients aged ≥70 years (n = 132; group 1) were compared with patients aged < 70 years (n = 270; group 2). In group 1, 20% of patients had no typical cardiac pain versus 6% in group 2 (p < 0.01). History of previous AMI, Q-wave AMI and peak creatine kinase were not different in the 2 groups. In-hospital mortality was markedly higher in group 1 (27%) than in group 2 (8%), p < 0.01. Multivariate analysis revealed previous AMI, presentation without typical pain and age ≥70 years to be independently associated with the greatest relative risk. Post-AMI exercise testing, ejection fraction calculations and coronary angiography were all performed less often (p < 0.01); proven effective medical therapies, including thrombolysis, β blockers, acetylsalicylic acid and nitrates were all used less frequently (p < 0.01). The very high mortality and less aggressive management of elderly patients with AMI confirm similar data from our 1987 AMI patient cohort and other recently reported AMI patient outcome analyses. However, it remains uncertain why older patients with AMI are investigated and treated differently from younger patients. Further studies are warranted.