Woon V C, Lim K H
Division of Geriatric Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889.
Singapore Med J. 2003 Aug;44(8):414-8.
The aim of the study was to determine the differences in presentation, complications, management and outcome of elderly patients with acute myocardial infarction (AMI) compared to young patients.
All case-notes with a discharge or death diagnosis ofAMI between January and July 1999 at a restructured hospital in Singapore were reviewed retropectively. Patients were categorised into those younger than 65 years (young) and those 65 years or older (elderly). Data on the demographic and clinical profile of patients were collected.
There were 112 young and 101 elderly AMI patients. Chest pain was the most common presentation in both age groups, but more likely in the young than the elderly (89.3% vs 66.3%; p < 0.001). Atypical presentations were more likely in the elderly, with shortness of breath as the most common presentation (20.8% vs 5.4%; p < 0.001). The elderly were more likely to have complications of cardiac failure (65.3% vs 25%; p < 0.001) and cardiogenic shock (8.9% vs 0.9%; p = 0.006). The elderly were less likely to receive thrombolytic therapy (35.8% vs 64.8%; p < 0.001) as they were more likely to have contraindications (34.5% vs 6.8%; p = 0.002). The elderly were also less likely to receive beta-blockers (21.8% vs 60.7%; p < 0.001). In-hospital mortality was higher in the elderly (20.8% vs 2.7%; p < 0.001). Cardiogenic shock complicating AMI was associated with high in-hospital mortality.
In AMI patients, chest pain was the most common presentation in both age groups, though less frequently in the elderly. Atypical presentations were more likely in the elderly, with shortness of breath as the most common atypical presentation. In elderly AMI patients, prevalence of cardiac failure was higher, use of beta-blockers was lower and in-hospital mortality was higher than young patients.
本研究旨在确定老年急性心肌梗死（AMI）患者与年轻患者在临床表现、并发症、治疗及预后方面的差异。
回顾性分析新加坡一家重组医院1999年1月至7月间所有出院或死亡诊断为AMI的病历。患者分为年龄小于65岁（年轻组）和65岁及以上（老年组）。收集患者的人口统计学和临床资料。
共有112例年轻AMI患者和101例老年AMI患者。胸痛是两个年龄组最常见的表现，但年轻组比老年组更常见（89.3%对66.3%；p<0.001）。非典型表现多见于老年组，最常见的是气短（20.8%对5.4%；p<0.001）。老年患者更易发生心力衰竭并发症（65.3%对25%；p<0.001）和心源性休克（8.9%对0.9%；p=0.006）。老年患者接受溶栓治疗的可能性较小（35.8%对64.8%；p<0.001），因为他们更易有禁忌证（34.5%对6.8%；p=0.002）。老年患者接受β受体阻滞剂治疗的可能性也较小（21.8%对60.7%；p<0.001）。老年患者住院死亡率较高（20.8%对2.7%；p<0.001）。并发心源性休克的AMI患者住院死亡率较高。
在AMI患者中，胸痛是两个年龄组最常见的表现，不过老年组较少见。非典型表现多见于老年组，气短是最常见的非典型表现。老年AMI患者心力衰竭患病率较高，β受体阻滞剂使用率较低，住院死亡率高于年轻患者。
