Clinical Presentation and Outcomes in Real-Life Management of Elderly Patients Aged ≥75 Years Presenting with Acute Myocardial Infarction

• Published in: Anatolian journal of cardiology Vol. 26; no. 4; pp. 286 - 297
• Main Authors: Özdoğan, Öner, Kayıkçıoğlu, Meral, Kılıçkap, Mustafa, Ekmekçi, Cenk, Küçükukur, Murat, Yalçın, Ahmet Arif, Erol, Mustafa Kemal
• Format: Journal Article
• Language: English
• Published: Turkey Turkish Society of Cardiology 01-04-2022; KARE Publishing
• Subjects: acute myocardial infarction; Aged; Coronary Angiography; coronary artery disease; Humans; Myocardial Infarction - therapy; Original Investigation; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; preventive cardiology; ptca/pci; Registries; Risk Factors; Treatment Outcome
• ISSN: 2149-2263; 2149-2271
• DOI: 10.5152/AnatolJCardiol.2021.1096

The aim of this study was to provide insight into the real-life clinical presentation and outcomes of the elderly presenting with acute myocardial infarction from the Turkish Myocardial Infarction registry database.
TURKMI was a nationwide, multicenter, observational, 15-day snapshot registry conducted to address the management of acute myocardial infarction patients admitted to percutaneous intervention-capable hospitals. The present analysis included the comparison of consecutively enrolled acute myocardial infarction patients aged ≥75 and <75 years.
Of the overall 1930 patients, 362 patients were aged ≥75 years. Elderly patients were more likely to have hypertension and renal failure and less likely to have hypercholesterolemia. Elderly patients were admitted to hospitals almost 1 hour later mainly due to a late call to emergency medical service. At discharge, medical therapies were significantly less prescribed to the elderly. The proportion of patients undergoing coronary angiography was significantly lower in elderly (81.8% vs. 96.4%, P < .001). Both in-hospital and 1-year mortality were significantly higher in elderly patients (9.1% vs. 2.7% and 22.7% vs. 5.8%, P < .001 respectively). The adjusted risk of 1-year mortality was 4-fold in elderly (hazard ratio and 95% CI 4.0 [2.9-5.6], P < .001). In multivariate analysis, every 5-beat/min increase in heart rate increased mortality by 7%. Higher heart rate and use of antiplatelet agents on admission were predictors of mortality in elderly.
In real-life settings, elderly patients presenting with acute myocardial infarction are prone to prolonged total ischemic time and are subjected to less-intensive medical treatment and interventional approaches. Besides age, the increased heart rate could be the major determinant of mortality.