Clinical characteristics of acute myocardial infarction in very elderly patients / 天津医药

ABSTRACT

Objective To analyze the clinical characteristics of very elderly patients (age ≥80 years) with acute myocardial infarction (AMI) and to provide basis for the treatment and prevention of AMI. Methods The clinical data of 296 patients with ST-segment elevation AMI who admitted in the Second Hospital of Tianjin Medical University during May 2012 to July 2014 were retrospectively analyzed. The patients were divided into very elderly group (≥80 years old, n=54), elderly group (60-79 years old, n=148) and younger group (<60 years old, n=94). The clinical baseline data, infarction area, imaging data, medication in-hospital and adverse cardiovascular events were compared between the three groups. Results The proportion of smoking, diastolic blood pressure, triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), erythrocyte count (RBC) and hemoglobin (HGB) at admission were significantly lower in the very elderly group. Results of electrocardiogram (ECG) showed mainly anterior wall infarction in three groups, and there were higher proportions of multiple infarcts in very elderly group and elderly group than those of younger group (31.5%vs. 31.8%vs. 17.0%,χ2=6.994, P < 0.0167). Coronary angiography (CAG) indicated that the target vessels were mostly right coronary arteries ( 61.1%) in very elderly group, while they were mainly left anterior descending (proportions were 50.7% and 43.6% respectively) in elderly group and the younger group. The proportion of high thrombotic load, the proportion of temporary cardiac pacing and no-reflow rate were significantly higher but the proportion of percutaneous coronary intervention (PCI) was lower in the very elderly group than those of younger group. The result of ultrasonic cardiogram (UCG) illustrated that the diameter of the left atrial diameter (LAD) and the left ventricular end-systolic dimension(LVDs) were larger in very elderly group than those of younger group (P<0.0167). The left ventricular ejection fraction (LVEF) was lower in the very elderly group and the elderly group than that of the young group, and the incidence of ventricular aneurysm was higher than that of the young group.During the hospitalization, the percentage of using diuretics, positive inotropic drugs and intraoperative tirofiban were higher in the very elderly group than those of elderly group and younger group. Meanwhile, all-cause mortality, the percentage of new-onset atrial fibrillation (NOAF) and the percentage of atrioventricular block were also higher in the very elderly group compared with those of other two groups (P < 0.0167). Conclusion The very elderly patients with AMI are generally related with complex diseases and more postoperative complications. It is important to perform the blood vessel recanalization early according to the specific conditions, and to assess the risk of postoperative bleeding, thrombosis and other related risks in order to select the appropriate treatment with low mortality and less risk of hospital complications in the very elderly patients with AMI.