Myocardial infarction in the elderly. Clinical and therapeutic differences.

BACKGROUND

The progressive aging of society results in increased numbers of acute myocardial infarctions (MI) in the elderly. In the presence of huge progress in MI treatment, it seems to be reasonable to analyse clinical course and prognosis in the elderly with MI.

AIM

To assess differences in clinical characteristics and treatment of MI between patients younger than 65 and the elderly.

METHODS

A total of 491 patients over 65 and 398 patients younger than 65 with acute MI between June 2005 and February 2006 were retrospectively analysed.

RESULTS

In patients over 65 there was significantly higher prevalence of arterial hypertension and diabetes, as well as low left ventricular ejection fraction and advanced heart failure. The time from onset of symptoms to admission was longer in the older group. The rate of reperfusion therapy in the elderly was significantly lower, and the results of invasive treatment were poor. Antiplatelet treatment was less aggressive in this group. In-hospital and long-term mortality were significantly higher in patients over 65, but the lowest in subjects undergoing invasive strategy.

CONCLUSIONS

Risk factors in baseline characteristics and lower rate of invasive therapeutic strategy result in worse prognosis in patients over 65 with acute MI. A significant reduction in mortality due to the invasive approach should encourage wide implementation of this approach in the elderly.