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 (≥75 years) compared with middle aged (66 to 74 years) and younger (≤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).