Bhatia Lovleen C, Naik Ruchi H
Department of Medicine, MM Institute of Medical Sciences Research, Ambala, Haryana, India.
J Cardiovasc Dis Res. 2013 Jun;4(2):107-11. doi: 10.1016/j.jcdr.2012.07.003. Epub 2013 Jun 18.
The aim of study was to determine the difference in presentation, risk factors, complications, management and outcome of elderly and young patients with acute myocardial infarction (AMI).
Tertiary care center; prospective observational study.
The study included 200 consecutive patients with AMI admitted in the ICCU, in a tertiary care center in West India. The group I consisted of 107 patients aged equal to or above 65 years and the group II consisted of 93 patients aged below 65 years.
Two tailed student's t test and Chi-square statistics (Fisher's test) for P value.
The male female ratio was 1.27:1 and 3.43:1 in group I and group II respectively. Atypical presentations were more likely in the elderly, with shortness of breath as the most common presentation (40.18% versus 15.05%; P < 0.05. Risk factors like hypertension, dyslipidemia and diabetes were equally present in both groups but obesity, smoking and family history of coronary artery disease was more prevalent in younger age group (P < 0.05). The elderly were significantly less frequently revascularized (P < 0.05). Time from symptom onset to hospital admission was significantly longer in the case of elderly patients (P < 0.05). The elderly were more likely to have complications of cardiac failure (P < 0.05) and arrhythmias especially atrio-ventricular (AV) blocks. The elderly were also less likely to receive beta-blockers (P < 0.05). In-hospital mortality was higher in the elderly (P < 0.001).
We conclude that the manifestations of AMI are more subtle in the elderly, with different risk factors.
本研究的目的是确定老年和年轻急性心肌梗死（AMI）患者在临床表现、危险因素、并发症、治疗及预后方面的差异。
三级医疗中心；前瞻性观察研究。
本研究纳入了印度西部一家三级医疗中心心内科监护病房（ICCU）连续收治的200例AMI患者。第一组由107例年龄65岁及以上的患者组成，第二组由93例年龄低于65岁的患者组成。
采用双侧t检验和卡方统计（Fisher检验）计算P值。
第一组和第二组的男女比例分别为1.27:1和3.43:1。老年患者非典型表现更为常见，最常见的表现为气短（40.18%对15.05%；P<0.05）。高血压、血脂异常和糖尿病等危险因素在两组中同样常见，但肥胖、吸烟和冠心病家族史在年轻组中更为普遍（P<0.05）。老年患者进行血运重建的频率显著较低（P<0.05）。老年患者从症状发作到入院的时间明显更长（P<0.05）。老年患者更易发生心力衰竭并发症（P<0.05）和心律失常，尤其是房室传导阻滞。老年患者接受β受体阻滞剂治疗的可能性也较小（P<0.05）。老年患者的院内死亡率更高（P<0.001）。
我们得出结论，AMI在老年人中的表现更为隐匿，且存在不同的危险因素。
