Infarto agudo do miocárdio em pacientes acima de 70 anos: estudo de 51 casos / Acute myocardial infarction in patients over age 70: study of fifty-one patients

RESUMO

Objetivo: Descrever a evoluçäo intra-hospitalar de pacientes acima de 70 anos com Infarto Agudo do Miocárdio (IAM). Cauística e Métodos: 51 pacientes (36 homens) acima de 70 anos, internados entre 1984 e 1988, com diagnóstico de IAM. Resultados: Chegaram ao hospital com até 4 horas de dor 49,1% dos pacientes. As complicaçöes foram divididas em mecânicas, elétricas, ambas associadas, isquemia persistente e outras. 84.3% dos pacientes tiveram complicaçöes na Unidade de Terapia Intensiva (UTI), e 50,0% na enfermaria. No acometimento de face anterior, as complicaçöes mais freqüentes foram as taquiarritmias e, na face diafragmática, os bloqueios átrio-ventriculares. Näo houve diferença significativa na incidência das complicaçöes mecânicas, comparadas as faces atingidas. Houve diferença significativa (p < 0,05) na leatalidade, de acordo com o tempo de chegada ao hosptial, mas näo em relaçäo a face atingida. Dos pacientes com insuficiência cardíaca associada a choque cardiogênico faleceram em 93,3%. Houve alta incidência de complicaçöes na UTI, com óbitos relacionados a doença isquêmica e, na enfermaria, de causas näo relacionadas diretamente a coronariopatia. Conclusäo: O IAM em pacientes acima de 70 anos apresenta morbidade e mortalidade, significativamente menores nos pacientes que procuram precocemente o hospital

ABSTRACT

Purpose: To describe the clinic evolution during admission of a group of patients over age 70, who experienced acute myocardial infarction (AMI). Patients and Methods: Fifty-one patients, over age 70, with confirmed diagnosis of AMI, were studied. Thirty-six (70.6%) males and 15 (29.4%)females. Results: Near half (49.1%) were admitted before four hours of beginning of pain. The complications were divided into mechanical, electrical, persistent ischemia and others, not related with coronary heart disease. In the coronary care unit (CCU), 84.3% of patients complicated, and 50,0% at the ward. AMI of the anterior wall complicated more frequently with tachiarrythmia, and inferior wall with atrioventricular block. There were not statistical difference in the incidence of mechanical complications, according to the affected wall. There was statistical significance (p < 0.05) comparing mortality and the time elapsed between beginning of pain and hospital admission, but not comparing mortality and the wall involved. The patients with congestive heart failure and cardiogenic shock died in 93.3%. Mortality at the CCU was mostly related to complications of AMI, but mortality at ward to other complications not directly related with coronary heart disease. Conclusion: Myocardial infarcrion over age 70 implies high mortality and morbidity, with significantly, better prognosis with earlier arrival of the patient to the hospital.