scholarly journals MODERN ASPECTS OF MYOCARDIAL INFARCTION TREATMENT IN OLDER PATIENTS

2020 ◽  
Author(s):  
Kirill L. Kozlov ◽  
Andrey N. Bogomolov ◽  
Nikolay G. Lukianov ◽  
Ekaterina I. Senkina ◽  
Anastasia E. Pukhalskaya
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Elderly Patients ◽  
Older Patients ◽  
Myocardial Revascularization ◽  
Interventional Cardiology ◽  
The Elderly ◽  
High Rate ◽  
Old Patients ◽  
Meta Analyses

Acute myocardial infarction is one of the most socially important diseases with a high rate of mortality and disability. Cardiovascular heart disease represents the leading cause of death in people those over 65 years. In elderly and old patients atypical forms of myocardial infarction are common. High rate of comorbidities, functional and socioeconomic status, side effects associated with drug administration create difficulty in the diagnosis and selection of treatment in the elderly. These patients need a prolonged monitoring with using an additional examinations and dynamic observation. Compared to younger subjects, elderly patients with acute myocardial infarction are less likely to receive evidence-based treatment, including myocardial revascularization therapy. Endovascular revascularization is currently the main standard for the treatment of acute myocardial infarction, but the advantage of the use of interventional cardiology techniques in elderly patients has been insufficiently studied. Older patients are generally underrepresented in cardiovascular trials. Modern scientific literature, illuminating issues of application of pharmacological and endovascular treatment of acute myocardial infarction in elderly and old age patients, contains fragmented and, in some cases, contradictory data. The authors have taken an attempt to systemize current information in this field based on recommendations, major studies and meta-analyses.

scholarly journals Acute myocardial infarction in elderly patients: comparative analysis of the predictors of mortality. The elderly versus the young

2002 ◽  
Vol 79 (4) ◽  
pp. 369-374 ◽  
Author(s):  
Marisa F. Leal ◽  
Newton Fernando Stadler de Souza Filho ◽  
Hermínio Haggi Filho ◽  
Estela Regina Klosoviski ◽  
Eva Cantalejo Munhoz
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Comparative Analysis ◽  
Elderly Patients ◽  
The Elderly ◽  
Predictors Of Mortality

scholarly journals CLINICAL PRESENTATION OF ACUTE MYOCARDIAL INFARCTION IN ELDERLY PATIENTS

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Rajesh Kumar Singhal ◽  
Harsha Kumar Gowardhan
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Elderly Patients ◽  
The Elderly ◽  
Shortness Of Breath ◽  
Cross Sectional ◽  
Clinical Presentations ◽  
Myocardial Infraction

Background: The cardiovascular diseases (CVDs) have become the leading cause of mortality worldwide. There is an increasing burden on health care systems associated with MIs in the elderly, differences in clinical picture, and difficulties in dealing with elderly patients with myocardial infraction (MI). Aim: The aim of study is to evaluate the different clinical presentations, risk factors and complications of elderly patients presenting with acute myocardial infarction. Methods: This is a retrospective, cross sectional study done over a period of 1 year. A total of 100 elderly patients who were diagnosed as AMI were included in the study. We studied Demographic features, cardiovascular risk factors, varied clinical presentations Electrocardiogram (ECG) findings from the history proformas and documented. Results: A total of 100 patients diagnosed with MI were studied. Mean age of the study population was 69.41 years and were predominantly male (84%). The most common presenting symptom was chest pain (79%) followed by sweating (7%), followed by shortness of breath (5%), giddiness (4%) vomiting (3%) and palpitations (2%). hypertension was commonly seen in elderly (56%) followed by diabetes (39%), smoking (28%), dyslipidaemias (12%), history of CAD (9%) and obesity (6%).  Mortality rate was 26% and maximum (11%) patients belonged to age group >80 years. Conclusion: We conclude that chest pain is the most common presentation in elderly AMI patients, but other atypical symptoms such as shortness of breath, giddiness, vomiting, without chest pain can also be the common presenting signs. Early and prompt management as appropriate should be provided to avoid morbidity and mortality in elderly. Keywords: Clinical Profile, Mortality, Myocardial Infarction, Risk Factors.

scholarly journals Multidimensional Prognostic Index (MPI) in elderly patients with acute myocardial infarction

2020 ◽  
Author(s):  
Valeria Cammalleri ◽  
Michela Bonanni ◽  
Francesca Maria Bueti ◽  
Andrea Matteucci ◽  
Lisa Cammalleri ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Mortality Rate ◽  
Elderly Patients ◽  
Primary Endpoint ◽  
Older Patients ◽  
Prognostic Index ◽  
World Population ◽  
Secondary Endpoints ◽  
Complications And Mortality

Abstract Background Management of elderly patients with acute myocardial infarction (AMI) is challenging due to lack of knowledge about the link between fragility, outcomes and interventional procedures. Aims The aim of this study was to establish the prognostic role of the Multidimensional Prognostic Index (MPI) in elderly with AMI. Methods A total of 241 patients ≥ 65 years old with AMI were continuously enrolled in this prospective study and divided into three groups according to the MPI score. The primary endpoint was 30-day mortality. Secondary endpoints were 6-month mortality and rate of adverse events. Results In-hospital overall mortality rate was higher in MPI-3 (p = 0.009). Patients of MPI-3 had a significantly higher mortality rate regarding the primary endpoint with 30-day survival of 78.9%, compared to 97.4% and 97.2%, in MPI-1, MPI-2 (p < 0.001), respectively. The survival rate progressively decreased in the three MPI classes of risk with a 6-month survival of 96.5%, 96.3%, 73.7% in groups MPI-1, MPI-2, and MPI-3 (p < 0.001). Longer length of in-hospital stay was observed in MPI-3 group. In-hospital complications were more frequent in higher MPI score. Discussion Our findings are in agreement with the results of other studies that evaluated the risk of in-hospital complications and mortality in older patients. In our “real-world” population of elderly hospitalized for AMI we observed poorer outcomes in patients belonged to higher MPI groups. Conclusions In the setting of AMI, MPI may be very useful in the daily clinical practice to manage older patients and predict the risk of in-hospital and follow-up complications.

scholarly journals Acute Myocardial Infarction During Hospitalization for Community-Acquired Pneumonia in Geriatric Patients: A Cross-Sectional Study

2020 ◽  
Author(s):  
Yu Kang ◽  
Xiang-Yang Fang ◽  
Dong Wang ◽  
Xiao-Juan Wang
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Respiratory Failure ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Geriatric Patients ◽  
The Elderly ◽  
Community Acquired Pneumonia ◽  
Cross Sectional

Abstract Background: Community-acquired pneumonia (CAP) and acute myocardial infarction cardiovascular (AMI) are two important health issues in elderly. Little is known regarding characteristics of AMI in elderly hospitalized for CAP. Therefore, we investigated the prevalence, characteristics compared with younger patients, impact on clinical outcomes and risk factors of AMI during hospitalization for CAP in geriatric patients.Methods: 11009 adult inpatients consisted of 5111 elderly patients≥ 65 years and 5898 patients＜65 years in respiratory ward and 1095 inpatients ≥65 years in geriatrics ward diagnosed with CAP were retrospectively analyzed by electronic medical records. Results: 159 (3.1%) elderly patients in respiratory ward and 77 (7.0%) patients in geriatrics ward experienced AMI during hospitalization for CAP. AMI were more frequently seen in elderly patients (3.1% vs. 1.0 %), Patients≥65 years who experienced AMI during hospitalization for CAP had higher percentage of respiratory failure (P = 0.001), hypertension (P = 0.008), dyspnea (P=0.046), blood urea nitrogen (BUN)≥7mmol/L (P < 0.001), serum sodium <130 mmol/L(P = 0.005) and had higher in-hospital mortality compared to patients＜65 years (10.1% vs. 6.6%). AMI was associated with increased in-hospital mortality (odds ratio, OR, with 95% confidence interval: 1.49 [1.24-1.82]; P<0.01). Respiratory failure (OR, 1.34 [1.15–1.54]; P<0.01), preexisting coronary artery disease (OR, 1.31[1.07–1.59]; P = 0.02), diabetes (OR, 1.26 [1.11–1.42]; P = 0.02), BUN (OR, 1.23 [1.01–1.49]; P = 0.04), and impaired consciousness (OR, 1.19 [1.07–1.32]; P = 0.03) were correlated with the occurrence of AMI in the elderly.Conclusions: The incidence of AMI during CAP hospitalization in geriatric patients is notable and have an impact on in-hospital mortality. Characteristics of the elderly differ from the general population. Particular attention should be paid to elderly patients with risk factors for AMI. Our study may represent useful information for clinical strategies aimed at preventing AMI and decreasing mortality in geriatric patients hospitalization for CAP.

scholarly journals Changes in Aerobic Capacity Over Time in Elderly Patients With Acute Myocardial Infarction During Cardiac Rehabilitation

2020 ◽  
Vol 44 (1) ◽  
pp. 77-84 ◽  
Author(s):  
Ki-Hong Kim ◽  
Yun-Chol Jang ◽  
Min-Keun Song ◽  
Hyeng-Kyu Park ◽  
In-Sung Choi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Elderly Patients ◽  
Cardiac Rehabilitation ◽  
Exercise Capacity ◽  
Coronary Intervention ◽  
The Elderly ◽  
Elderly Group ◽  
Target Heart Rate ◽  
Metabolic Equivalents

Objective To test the hypothesis that a longer duration of phase II cardiac rehabilitation is required to recover the exercise capacity of elderly patients compared to younger patients.Methods We retrospectively reviewed and analyzed the medical records of patients who were referred to our cardiac rehabilitation (CR) center and underwent percutaneous coronary intervention for acute myocardial infarction (AMI). A total of 70 patients were enrolled who underwent an exercise tolerance test (ETT) 3 weeks after the occurrence of an AMI (T0), 6 weeks after the first ETT (T1), and 12 weeks after the first ETT (T2). Patients older than 65 years were assigned to the elderly group (n=24) and those aged 65 years and younger to the younger group (n=46). Both groups performed center-based or home-based CR for 12 weeks (3 times per week and 1 session per day). Exercise intensity for each individual was based on the target heart rate calculated by the Karvonen formula. The change in maximal metabolic equivalents (MET<sub>max</sub>) of the two groups was measured at each assessment point (T0, T1, and T2) to investigate the recovery of exercise capacity.Results The younger group showed improvement in MET<sub>max</sub> between T0 and T1. However, MET<sub>max</sub> of the elderly group showed no significant improvement between T0 and T1. The exercise capacity, measured with MET<sub>max</sub>, of all groups showed improvement between T0 and T2.Conclusion Elderly patients with AMI need a longer duration of CR (>6 weeks) than younger patients with AMI.

scholarly journals Comparison of Six Decision Aid Rules For Diagnosis of Acute Myocardial Infarction In Elderly Patients Presenting To The Emergency Department With Acute Chest Pain

2021 ◽  
Author(s):  
Juraj Hrečko ◽  
Jiří Dokoupil ◽  
Radek Pudil
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Department ◽  
Chest Pain ◽  
Elderly Patients ◽  
Predictive Value ◽  
Decision Aid ◽  
Real Life ◽  
The Elderly ◽  
Coronary Syndrome

Abstract Background: Using decision aid rules for diagnosis of acute myocardial infarction (AMI) is not common practice in our region. Elderly patients are often neglected in clinical trials, and the proper diagnostics of acute myocardial infarction in this group remains problematic. The objective of this study was to evaluate the accuracy and effectiveness of different strategies for the diagnosis of AMI in the elderly in real-life clinical practice. Methods: In a retrospective single-center study, we included patients older than 70 years presenting to the emergency department with chest pain as a dominant symptom. The performance of six decision aid rules (T-MACS, HEART, EDACS, TIMI, GRACE, and ADAPT) and solo troponin T strategy for diagnosing acute myocardial infarction was evaluated by calculating sensitivity, specificity, odds ratios, negative and positive predictive values.Results: A total of 250 patients, with a mean age of 78.5 years, were enrolled. Forty-eight patients (19.2%) had an acute myocardial infarction in a 30 day follow-up period. The sensitivity for ruling-out AMI was 100% for T-MACS, HEART, and ADAPT; 97.9% for EDACS, 93.8% for TIMI, and 81.3% for GRACE and solo TnT strategy. For ruling-in AMI, the specificity was 97.5% for T-MACS, 95% for TIMI, 83.2% for HEART, 81.7% for GRACE, and 46% for ADAPT. C-statistics were 0.52 for T-MACS, 0.51 for ADAPT, 0.47 for EDACS and GRACE, 0.46 for HEART and TIMI, and 0.33 for solo TnT strategy.Conclusion: T-MACS decision aid had the best performance with 100% sensitivity and 100% negative predictive value for rule-out AMI; 97.5% specificity and 64.3% positive predictive value for rule-in AMI. Other evaluated protocols were less accurate. Risk stratification of patients with suspected acute coronary syndrome based on decision aid rules can be used in real-life practice, even in the population of the elderly.

scholarly journals Prognostic value of early post-infarction angina in elderly patients

2005 ◽  
Vol 133 (5-6) ◽  
pp. 233-236 ◽  
Author(s):  
Predrag Erceg ◽  
Mladen Davidovic ◽  
Zorana Vasiljevic ◽  
Predrag Mitrovic ◽  
Vladan Vukcevic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Survival Analysis ◽  
Elderly Patients ◽  
The Elderly ◽  
Kaplan Meier ◽  
Myocardial Revascularisation ◽  
Coronary Events ◽  
Group 2 ◽  
Long Term Prognosis

Although numerous studies have shown that early post-infarction angina was a predictor of poor prognosis in patients with acute myocardial infarction, not a single study has considered this issue in the elderly. The goal of this study, based on a five-year follow-up of elderly patients with acute myocardial infarction, was to determine whether early post-infarction angina in the elderly had any influence on mortality and the incidence of additional coronary events. The study population consisted of 51 patients, aged 60 years or more, with acute myocardial infarction. Early post-infarction angina occurred in 31 subjects (Group 1), while it did not in 20 subjects (Group 2). Patients were monitored for five years and the incidences of death and new coronary events were recorded. A survival analysis was carried out using the Kaplan-Meier method. The survival analysis showed no difference between the observed groups concerning the following probabilities: death (p=0.9459), cardiac death (p=0.8253), myocardial reinfarction (p=0.7405), new coronary events (p=0.1708), unstable angina (p=0.1788), myocardial revascularisation (p=0.0691), and heart failure (p=0.7047j. In contrast to the younger population, where numerous studies have confirmed the link between early post-infarction angina and poor long-term prognosis, such findings could not be replicated in this study of the elderly population.

scholarly journals Outcome in elderly patients with myocardial infarction undergoing PCI using radial versus femoral access

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
V Kanic ◽  
F H Naji ◽  
G Kompara
Keyword(s):  
Myocardial Infarction ◽  
Elderly Patients ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
The Elderly ◽  
Access Site ◽  
Femoral Access ◽  
Funding Sources ◽  
Percutaneous Coronary ◽  
St Elevation

Abstract Background Radial access (RA) is increasingly used in interventional cardiology and has become the dominant access site for percutaneous coronary intervention (PCI). Data on the association between RA and outcome in elderly patients with myocardial infarction (MI) undergoing PCI are sparse and inconclusive. Purpose The aim of our study was to assess whether RA per se is associated with 30-day mortality in patients over 80 years of age with MI who underwent PCI at our center. Methods We retrospectively studied 639 consecutive patients aged over 80 years with MI who underwent PCI between January 2011 and December 2017. RA was used in 232 (36.3%) patients. Thirty-day mortality in the RA and femoral access (FA) groups was observed. Data were analyzed using descriptive statistics. Results RA patients had a significantly lower 30-day unadjusted mortality [30 (12.9%) patients died in the RA group compared to 102 (25.1%) patients in the FA group; p&lt;0.0001] (Figure 1). After adjusting for confounders, RA independently predicted better outcome (adjusted OR: 0.55; 95% CI: 0.32 to 0.90; p=0.025). Hypertension, ST-elevation MI, TIMI flow 0/1 after PCI, dual antiplatelet therapy, glomerular filtration rate, and bleeding predicted 30-day mortality. Conclusion RA leads to a better 30-day outcome in patients over 80 years of age with MI (ST-elevation MI and non-ST- elevation MI) who underwent PCI. RA was independently associated with mortality. This finding strengthens existing evidence that RA should be preferred whenever possible in the elderly with Mi. FUNDunding Acknowledgement Type of funding sources: None.

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