Acute Myocardial Infarction in the Elderly - The Differences Compared with the Young

VC Woon, KH Lim
Correspondence: Dr Woon Voon Ching, Voon_Ching_Woon@cgh.com.sg

ABSTRACT
Objectives The aim of the study was to determine the differences in presentation, complications, management and outcome of elderly patients with acute myocardial infarction (AMI) compared to young patients.
Materials and Methods All case-notes with a discharge or death diagnosis of AMI between January and July 1999 at a restructured hospital in Singapore were reviewed retropectively. Patients were categorised into those younger than 65 years (young) and those 65 years or older (elderly). Data on the demographic and clinical profile of patients were collected.
Results There were 112 young and 101 elderly AMI patients. Chest pain was the most common presentation in both age groups, but more likely in the young than the elderly (89.3% vs 66.3%; p < 0.001). Atypical presentations were more likely in the elderly, with shortness of breath as the most common presentation (20.8% vs 5.4%; p < 0.001). The elderly were more likely to have complications of cardiac failure (65.3% vs 25%; p < 0.001) and cardiogenic shock (8.9% vs 0.9%; p = 0.006). The elderly were less likely to receive thrombolytic therapy (35.8% vs 64.8%; p < 0.001) as they were more likely to have contraindications (34.5% vs 6.8%; p = 0.002). The elderly were also less likely to receive beta-blockers (21.8% vs 60.7%; p < 0.001). In-hospital mortality was higher in the elderly (20.8% vs 2.7%; p < 0.001). Cardiogenic shock complicating AMI was associated with high in-hospital mortality.
Conclusion In AMI patients, chest pain was the most common presentation in both age groups, though less frequently in the elderly. Atypical presentations were more likely in the elderly, with shortness of breath as the most common atypical presentation. In elderly AMI patients, prevalence of cardiac failure was higher, use of beta-blockers was lower and in-hospital mortality was higher than young patients.

Keywords: atypical, cardiac failure, cardiogenic shock, presentation, shortness of breath
Singapore Med J 2003; 44(8): 414-418