Acute myocardial infarction in the elderly: differences by age

• Published in: Journal of the American College of Cardiology 2001-09, Vol.38 (3), p.736-741
• Main Authors: Mehta, Rajendra H, Rathore, Saif S, Radford, Martha J, Wang, Yongfei, Wang, Yun, Krumholz, Harlan M
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aged, 80 and over; Biological and medical sciences; Cardiology. Vascular system; Coronary heart disease; Female; Heart; Humans; Male; Medical sciences; Myocardial Infarction - epidemiology; Myocardial Infarction - mortality; Odds Ratio; United States - epidemiology
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(01)01432-2

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 ≥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 ≥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%, ≥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.