[Age as a factor in the clinical and prognostic picture and the incidence of myocardial infarct].

The purpose of this review is to determine whether advancing age is an independent predictor of increased mortality after acute myocardial infarction (AMI). Atypical presentations of infarction-related symptoms in the elderly are common, with consequent delay in the diagnosis and treatment. Advancing age is associated with changes in cardiovascular structure and function, that might predispose to adverse outcome of the older infarcted patient, who presents more frequent previous coronary events, ventricular hypertrophy and heart failure. Non cardiac unfavorable data, such as impaired renal function, diabetes and hypertension, are also frequently associated. In elderly patients, several complications of AMI are more common, as external cardiac rupture, cardiogenic shock, heart failure, conduction disturbances. On the contrary, lower values of cardiac enzymes, indicating a lower amount of myocardial necrosis, are observed in older patients. AMI complications are related to the more frequent mortality in elderly patients. The medications proven to reduce mortality, as thrombolytic therapy, aspirin, heparin, beta-blockers, are less frequently employed than in younger patients, despite similarities in a variety of clinical indexes of the extent of myocardial damage. After AMI, coronary angiography is also performed less often in elderly patients; consequently myocardial revascularization with angioplasty or aortocoronary bypass are less employed, despite undoubted therapeutic advantages at all ages. In patients more than 70 years old, AMI affects the female gender more than men; these data involve other particular problems concerning prognosis and therapy. The present benefits, as pointed out by the recent progress in AMI therapy, must be employed in the treatment of older infarcted patients. They go on to suggest that more aggressive management in elderly patients should be evaluated for its potential to reduce mortality.