Acute myocardial infarction in the very elderly. A comparison with younger age groups

In a consecutive series of 2312 patients with acute myocardial infarction (AMI) admitted from 1973 till 1979, 188 were 80 years or older (group III). They were compared with 1167 patients younger than 65 years (group I) and 957 aged 65 to 79 years (group II). The sex ratio (males/females) fell from 5.46 in group I to 0.9 in group III. Group III patients had more frequently a history of previous heart failure and more often atypical or no chest pain before admission. Less group III patients were admitted within 4 hours after onset of symptoms, but the incidence of heart failure, pulmonary edema and cardiogenic shock on admission and during CCU stay was definitely higher than in younger patients. Atrial arrhythmias, 2nd and 3rd degree atrioventricular block, complete bundle branch block and intraventricular conduction disturbances occurred more frequently in group III. The electrocardiographic extent and location of the infarction and peak enzyme levels were similar in the three groups. Mortality in group III was 43.6% at the 28th day and 76.6% at one year after AMI. At different intervals after the onset of AMI mortality increased progressively from group I to III. Age by itself, probably on the basis of definite structural changes of the heart and of other organs occurring during aging, leads to higher early and late mortality in very elderly people.     

老年急性心肌梗死住院患者临床特点及急诊介入治疗的近期疗效

目的评价急诊经皮冠状动脉介入治疗(PCI)对老年急性心肌梗死(AMI)患者住院期间的疗效。方法将沈阳军区总医院心血管中心从1995年12月至2006年6月收治的1337例AMI患者分为老年组(≥60岁,771例)和非老年组(<60岁,566例),于发病24h内行急诊PCI,比较两组患者的临床和冠脉造影特征、PCI成功率及术后并发症发生率。结果老年组有高血压、糖尿病、典型心绞痛等病史患者显著多于非老年组(P<0.05);老年组女性、非ST段抬高型AMI、急性左心衰、心源性休克患者显著多于非老年组(P<0.05);而非老年组吸烟和有高脂血症病史患者显著多于老年组(P<0.05)。老年组3支病变率为63.8%,显著高于非老年组的52.5%(P<0.01)。从发病至球囊扩张时间、PCI即刻成功率、无复流发生率、造影剂用量、术后住院时间在两组均无显著差异(P>0.05);术后心绞痛复发、再次心肌梗死、缺血性靶血管重建及非心脏并发症发生率两组亦无显著差异(P>0.05)。结论急诊介入治疗是老年AMI患者很好的可供选择治疗方法。     

外科急诊中以腹痛为主诉的老年急性心肌梗死23例临床分析

目的探讨以腹痛于外科急诊的老年急性心肌梗死（AMI）患者的临床特征,以减少误诊。方法回顾性分析23例以腹痛于外科急诊的老年AMI患者的临床资料,并选取同期以腹痛急诊于内科的老年AMI患者30例和以腹痛急诊于外科的老年急腹症患者40例作对照组。结果急诊于外科的老年AMI组有冠心病危险因素史比率高于外科急腹症组,伴胸闷占43．4％、心悸17．4％、心前区不适感者30．4％,均高于外科急腹症组（P值分别为0．005、0．035、0．005）;有外科腹痛史者高于内科急诊组（56．5％VS26．7％,P=0．028）;伴恶心、呕吐占60．9％,症状重,但腹部阳性体征少,心电图表现Ⅱ、Ⅲ、avF多见,常合并V7-V9改变;有就诊心电图记录者占78．3％,高于外科急腹症组、但低于内科急诊组（P值0．036、0．027）;行腹B超、立位腹平片检查高于就诊于内科组（52．2％,26．1％;P值0．006、0．015）。结论以腹痛急诊于外科的老年AMI患者有其临床特征,详细询问病史、认真查体、及时查心电图是避免延误治疗的关键。     

急性心肌梗死并发心脏破裂19例分析

目的 :探讨急性心肌梗死 (AMI)伴心脏破裂的临床特征、早期诊断及防治措施。方法 :对 AMI院内死亡的 112例患者中经心包穿刺或超声证实为心脏破裂者 19例 ,进行回顾性分析。结果 :年龄≥ 6 0岁者占 89.5 % ,女性发生率多于男性 (P <0 .0 5 ) ,首次发生梗死者 94.7% ,梗死累及广泛前壁者 89.5 % ,心脏破裂时 78.9%患者处于应激状态 ,所有患者均发生在 AMI第 1周内。心脏破裂 6 8.4%的患者表现为心跳骤停、电 -机械分离 ,其余表现为突然血压下降伴心包填塞或心力衰竭。结论 :AMI早期对老年、女性、首次发生的、特别是广泛前壁心肌梗死 ,应积极处理 ,避免增加心脏负担 ,防止心脏破裂。对疑有心脏破裂者 ,尽早行心包穿刺、超声检查 ,争取手术治疗     

Acute myocardial infarction in the elderly with diabetes

OBJECTIVE: Diabetes mellitus (DM) has been associated with an elevated, short-term risk of death after myocardial infarction (MI). Among the studies of DM, however, few studies have included elderly subjects. The purpose of the present investigation was to determine if non-insulin-treated DM (NIRxDM) and insulin-treated DM (IRxDM) were associated with specific comorbid conditions, clinical findings on arrival, and MI characteristics, as well as a higher 30-day mortality rate in elderly patients with acute MI. DESIGN: The study design was a retrospective medical record review and secondary data analysis of previously collected data from the Cooperative Cardiovascular Project. SETTING: Study setting was Connecticut from June 1, 1992, through February 28, 1993. PATIENTS: Subjects included the entire Medicare population (n = 2050), aged 65 years or older who were hospitalized for acute MI. OUTCOME MEASURES: Mortality rate at 30 days after MI was measured. RESULTS: A history of DM was observed in 29% of the study population. DM status was associated with previous comorbid conditions, poorer functional status, higher body mass index, heart failure on arrival, non-Q-wave MI, and development of atrial fibrillation and oliguria during hospitalization. Patients with DM were less likely to have chest pain on arrival to the hospital. Diabetic status was not a significant predictor of short-term mortality; at 30 days after MI, 17% (n = 242) of the subjects without DM, 19% (n = 71) of those with NIRxDM, and 18% (n = 39) of the subjects with IRxDM died (P = .460). After adjustment for other prognostic factors, it was noted that MI characteristics present on hospital arrival predicted mortality at 30 days in both patients with NIRxDM and patients with IRxDM. CONCLUSIONS: The slightly, but not significantly, increased mortality risk in patients with DM should not minimize the importance of monitoring DM in the acute MI setting. Hospitalization for MI provides an opportunity to provide aggressive lipid and blood pressure management, optimize blood glucose, control heart failure, and institute other secondary preventive interventions in the elderly population with DM.     

Acute myocardial infarction in the elderly

Cardiovascular disease is the most common cause of death in the elderly. In fact, the cardiovascular disease is the number one cause of death in women and the number two cause in men of 65 years or over in Japan. We studied the clinical characteristics and significances of acute myocardial infarction as they relate to the aged.     

急性心肌梗死并发急性左心衰57例临床分析

目的探讨急性心肌梗死并发急性左心衰临床特点,总结临床诊治经验。方法对我院57例急性心肌梗死并发急性左心衰患者进行回顾性分析。结果临床表现以胸闷、心前区疼痛、气促、呼吸困难为主,34例可见ST缺血改变,10例可见病理性Q波,有43例cTnI高于正常。结论急性心肌梗死并发急性左心衰病情危急,临床表现多样,及时治疗是关键。     

非冠状动脉粥样硬化性心肌梗死11例分析

目的探讨非冠状动脉硬化性心肌梗死诊治。方法我院近2年收治非冠状动脉硬化性心肌梗死11例,每例行超声心动图、左室造影和冠状动脉造影检查,分析其临床特征。结果11例非冠状动脉硬化性心肌梗死患者冠状动脉造影检查均未发现局限性狭窄或斑块。结论非冠状动脉硬化性心肌梗死应尽早冠脉造影,对因治疗。     

Contemporary clinical outcomes of primary percutaneous coronary intervention in elderly versus younger patients presenting with acute ST-segment elevation myocardial infarction

Background: Primary percutaneous coronary intervention (PPCI) is the choice reperfusion strategy for acute ST‐segment elevation myocardial infarction (STEMI). However, data on PPCI in elderly patients are sparse. This study determined clinical outcome post‐PPCI in elderly versus younger patients with STEMI. Methods and Results: A cohort of 790 consecutive STEMI patients was studied for survival and major adverse cardiovascular events (MACE) after PPCI using a precise cardiac catheterization protocol. Patients were divided into two groups: those ≥75 years (elderly) and those <75 years. Median door‐to‐balloon time (DBT) was 82 minutes in the elderly versus 66 minutes in the younger group (P = 0.002). In‐hospital all‐cause mortality was higher in the elderly group (15.5% vs. 2.7%, P < 0.001). In elderly patients, MACE were found to be higher (32.3% vs. 16.1%, P < 0.001). Using a multivariate logistic regression analysis, age (odds ratio [OR]= 1.04, 95% confidence interval [CI]= 1.02–1.05, P < 0.001), diabetes (OR = 2.17, 95% CI = 1.33–3.53, P = 0.002), renal failure (OR = 3.75, 95% CI = 1.30–10.79, P = 0.014) and coronary artery disease (OR = 1.61, 95% CI = 1.00–2.59, P = 0.050) were associated with higher in‐hospital MACE, while age (OR = 1.05, 95% CI = 1.02–1.08, P = 0.001), diabetes (OR = 2.18, 95% CI = 1.06–4.47, P = 0.034) and renal failure (OR = 6.65, 95% CI = 2.01–22.09, P = 0.002) were associated with higher in‐hospital mortality. Kaplan–Meier 1‐year survival rate was lower in the elderly. Conclusions: In a contemporary population of STEMI patients treated with PPCI, overall in‐hospital MACE and mortality remain higher in elderly compared to younger patients. Although partly due to higher burden of preexisting comorbidities, a higher DBT may also be responsible. (J Interven Cardiol 2011;24:357–365)     

Acute myocardial infarction: contemporary risk and management in older versus younger patients

The in-hospital management and risk of death of 101 patients 70 years of age or older with acute myocardial infarction in 1987 (group 1) were compared with management and risk for 106 temporally matched patients less than 70 years old (group 2). In group 1, 49% had histories of previous myocardial infarction, compared to 25% in group 2 (P less than 0.001), and 23% of group 1 presented without cardiac pain, versus 7% of group 2 (P less than 0.001). Among the younger patients, other conventional risk factors were, in contrast, more common (Q wave infarction 84% in group 2 versus 70% in group 1; P less than 0.05) or higher (peak creatine kinase values 2222 iu/L in group 2 versus 1366 iu/L in group 1; P less than 0.001). Prior to infarction, all cardiac drugs were used more frequently in the older group 1 patients, whereas post infarction thrombolysis, beta-blockers and acetylsalicylic acid use were all more common (P less than 0.01 to P less than 0.001) in the younger group 2 patients. Post infarction exercise testing, left ventricular ejection fraction calculations and coronary angiography were all performed less frequently in group 1 (P less than 0.001). The in-hospital mortality was 35% for group 1 versus 7% for group 2 (P less than 0.001). Among all 207 study subjects, multiple logistic regression revealed thrombolysis, absence of cardiac pain, and age 70 years or older to be associated with the greatest relative mortality risk. Increased relative risk to a lesser degree was associated with previous infarction, male sex and post infarction use of antiarrhythmic medication.(ABSTRACT TRUNCATED AT 250 WORDS)     

Acute myocardial infarction during pregnancy: A clinical checkmate

Acute myocardial infarction (AMI) in pregnancy is associated with high morbidity and mortality. Management of these patients can be challenging as little is known about the optimal management strategy. Medications routinely used may have harmful effects on the pregnancy outcome. In addition, AMI could occur in the absence of atherosclerotic disease. We describe optimal management strategy by eliciting the management of a 45-year-old female with ST segment elevation myocardial infarction. We recommend early use of coronary angiography to define the pathology in such cases. Radial artery assess should be preferred. Pregnant patients with AMI due to atherosclerotic disease should be given a 325 mg of aspirin and 600 mg of clopidogrel and either balloon angioplasty or bare metal stent should be used for revascularization. Percutaneous coronary intervention with heparin is preferred over bivalirudin and later should be reserved for patients with severe heparin allergy.     

老年急性白血病340例临床分析

目的分析老年急性白血病的分布及预后情况。方法选取2009年9月至2013年5月在我院未经治疗的、年龄大于60岁的急性白病患者340例,对其发病年龄、预后危险因素、治疗、生存时间等指标进行分析。结果340例60岁以上老年急性白血病患者中,中位发病年龄68岁,急性淋巴细胞白血病（ALL）24例（7.06%）;在急性髓细胞白血病（AML）314例中,初发AML（de novo AML）250例（79.62%）。急性早幼粒细胞白血病（APL）仅9例。初发AML （非APL）中细胞遗传学和分子生物学预后较好的34例（14.11%）,预后差的61例（25.31%）,随着年龄增加,预后较好的比例降低,而预后差的比例升高。在有生存资料的患者93例中,85例选择了化疗。年龄也对完全缓解（CR）率、总体生存有显著影响。化疗后获得CR的患者生存明显优于未获得CR的患者。结论老年急性白血病患者预后差,如何提高总体生存仍然是一个难题。     

小于50岁急性心肌梗死患者的临床特点

目的:探讨年龄50岁急性心肌梗死(AMI)患者的临床特点。方法:以246例临床确诊的初发AMI患者为研究对象,按年龄分为50岁组与50岁组,比较两组的临床资料。结果:年龄50岁AMI患者的男性比例、吸烟率、饮酒率、血清胆固醇水平、左室射血分数、广泛前壁心梗发生率、单支病变率、介入治疗率均显著高于50岁组患者;而左室舒张末期内径、急性左心衰发生率、室壁瘤发生率及住院期间病死率显著低于50岁组患者(P0.05)。结论:年龄50岁的AMI患者的临床特点与50岁患者有诸多不同。     

糖尿病酮症酸中毒合并急性心肌梗死14例临床分析

目的 探讨糖尿病酮症酸中毒(DKA)合并急性心肌梗死(AMI)的发病情况及临床特点.方法 回顾性分析我院1998～2006年共14例2型糖尿病酮症酸中毒合并AMI患者的临床资料.结果 1998～2006年共检出DKA合并AMI患者14例;发病时同时诊断DKA合并AMI者11例,占79%;先出现DKA后出现AMI者3例,占21%;DKA合并AMI发病时以气促、消化道症状和糖尿病典型"三多"症状多见,伴随胸痛者只有29%;心电图表现为非ST段抬高性心肌梗死(NSTEMI)者6例,占43%;所有患者发病时心功能均明显降低,Killip分级3～4级者占71%;治疗上均按DKA和AMI原则处理,但限制补液量,14例患者中经抢救治疗后8例死亡(57%),含3例合并慢性肾衰竭尿毒症患者.结论 DKA合并AMI患者AMI多与DKA同时发生亦可后发,且AMI表现多不典型,发病时心功能差,病死率高.     

家庭无创正压机械通气联合康复锻炼对慢性阻塞性肺疾病患者呼吸肌肌力的影响

目的评估家庭无创正压机械通气联合康复锻炼对稳定期重度慢性阻塞性肺疾病（COPD）患者呼吸肌肌力的影响。方法将56例经住院治疗处于稳定期的重度COPD患者分为无创呼吸机＋呼吸操组（治疗组,n=26）和无创呼吸机组（对照组,n=30）。分别观察治疗前、治疗后2年两组患者的最大吸气压（MIP）、跨膈压（Pdi）、最大跨膈压（Pdimax）及Pdi/Pdimax、CO_2分压（PaCO_2）、肺功能、6min行走距离（6MWD）、病死率及再住院率等指标。结果两组年龄、性别、COPD病程、体质量指数、PaCO_2、PaO_2、MIP、Pdi、Pdimax及Pdi/Pdimax、第一秒用力呼气容积实测值与预计值的比值（FEV_1%）、第一秒用力呼气容积占用力肺活量比值（FEV_1/FVC%）、6MWD和每年住院次数均具有可比性（均P〉0.05）。2的年后治疗组MIP,Pdi,Pdimax及Pdi/Pdimax,6MWD,每年住院次数分别为（76±6）cmH_2O,（48±5）cmH_2O,（126±11）cmH_2O,（0.38±0.01）,（263±33）m和（2.1±0.9）次/年,与对照组[（72±5）cmH_2O,（45±4）cmH_2O,（116±8）cmH_2O,（0.39±0.02）,（244±26）m,（2.6±0.9）次/年]比较均具有统计学意义（均P〈0.05）。治疗组死亡1例（1/26）,对照组2例（2/30）,两组比较差异无统计学意义（χ~2=0.02,P〉0.05）。结论长期家庭无创正压机械通气联合呼吸操康复锻炼治疗可以有效提高稳定期重度COPD患者呼吸肌肌力及呼吸肌耐力,改善运动功能,从而达到更好的长期治疗效果。     

Acute myocardial infarction in the elderly: differences by age

OBJECTIVES: We evaluated the clinical characteristics and outcomes of elderly patients hospitalized with acute myocardial infarction (AMI) to describe differences by age. BACKGROUND: Elderly patients with AMI are perceived as a homogeneous population, though the extent by which clinical characteristics vary among elderly patients has not been well described. METHODS: Data from 163,140 hospital admissions of Medicare beneficiaries age > or =65 years between 1994 and 1996 with AMI at U.S. hospitals were evaluated for differences in clinical characteristics and mortality across five age-based strata (in years): 65 to 69, 70 to 74, 75 to 79, 80 to 84 and > or =85. RESULTS: Older age was associated with a greater proportion of patients with functional limitations, heart failure, prior coronary disease and renal insufficiency and a lower proportion of male and diabetic patients. Of note, the proportion of patients presenting with chest pain within 6 h of symptom onset, and with ST-segment elevation, was lower in each successive age group. Thirty-day mortality rates were higher in older age groups (65 to 69: 10.9%, 70 to 74: 14.1%, 75 to 79: 18.5%, 80 to 84: 23.2%, > or =85: 31.2%, p = 0.001 for trend). The effect of age persisted but was attenuated after adjustment for differences in patient characteristics; similar trends were observed for one-year mortality. CONCLUSIONS: Our data indicate significant age-associated differences in clinical characteristics in elderly patients with AMI, which account for some of the age-associated differences in mortality. The practice of grouping older patients together as a single age group may obscure important age-associated differences.