Mahon N G, Codd M B, O'Rorke C, Egan B, McCann H A, Sugrue D D
Department of Clinical Cardiology, Mater Misericordiae Hospital, Dublin, Ireland.
J Am Geriatr Soc. 1999 Mar;47(3):291-4. doi: 10.1111/j.1532-5415.1999.tb02991.x.
Acute myocardial infarction (AMI) is an important cause of mortality and morbidity in older patients. The aim of this study was to determine the proportion of unselected admissions with AMI that is older than 75 years and to examine management and outcomes in this group.
An historical cohort study of consecutive unselected admissions with AMI identified using the Hospital In Patient Enquiry (HIPE) database and validated according to MONICA criteria for definite or probable AMI.
An acute cardiac unit in a university teaching hospital/cardiac tertiary referral center.
Of 1059 patients, 606 (57%) were older than 65 years and 309 (29.2%) were older than 75 years. Mean age in this group was 80.5 years. Hospital mortality was almost twice as high as in patients younger than 75 years (28% vs 15%, P < .001), and age was an independent predictor of short- and long-term mortality following AMI. Women constituted a significantly higher proportion of older patients. Family history of AMI and cigarette smoking were less prevalent in older patients. Mean cholesterol was lower and comorbidities were higher. Other baseline characteristics, including previous AMI, did not differ. However older patients were less likely to receive thrombolysis (13% vs 36%, P < .001), aspirin (76% vs 86%, P < .01), or beta-blockers (25% vs 51%, P < .001) and were less likely to undergo cardiac catheterization or revascularization. Only 53% were admitted to coronary care.
Patients more than age 75 comprise almost one-third of patients with AMI and have a poor prognosis. Although age is an independent predictor of mortality following AMI, suboptimal management may contribute to the high mortality in these patients.
急性心肌梗死（AMI）是老年患者死亡和发病的重要原因。本研究的目的是确定年龄超过75岁的非选择性AMI入院患者的比例，并研究该组患者的治疗及预后情况。
一项历史性队列研究，通过医院住院患者查询（HIPE）数据库确定连续的非选择性AMI入院患者，并根据MONICA标准对确诊或可能的AMI进行验证。
一所大学教学医院/心脏三级转诊中心的急性心脏科。
在1059例患者中，606例（57%）年龄超过65岁，309例（29.2%）年龄超过75岁。该组患者的平均年龄为80.5岁。医院死亡率几乎是75岁以下患者的两倍（28%对15%，P<.001），年龄是AMI后短期和长期死亡率的独立预测因素。老年患者中女性所占比例显著更高。老年患者中AMI家族史和吸烟的情况较少见。平均胆固醇水平较低，合并症较多。其他基线特征，包括既往AMI史，无差异。然而，老年患者接受溶栓治疗的可能性较小（13%对36%，P<.001）、服用阿司匹林的可能性较小（76%对86%，P<.01）或服用β受体阻滞剂的可能性较小（25%对51%，P<.001），接受心脏导管插入术或血运重建的可能性也较小。只有53%的患者被收入冠心病监护病房。
75岁以上的患者占AMI患者的近三分之一，预后较差。虽然年龄是AMI后死亡率的独立预测因素，但治疗不充分可能导致这些患者的高死亡率。
