Aim Myocardial infarction without chest pain misleads the clinician, resulting in a diagnosis delay and an increase of mortality. The main objective of the present study was to determine the risk factors of atypical presentation in older patients with myocardial infarction. Methods All consecutive patients aged ≥75 years presenting with myocardial infarction and hospitalized in the cardiology intensive care unit were included in the present prospective multicenter observational study. All patients benefited from both specialized cardiac management and geriatric assessment. Results A total of 215 consecutive patients were included. The mean age was 85 ± 6 years. A total of 142 patients (66%) had a typical presentation (i.e. chest pain) and 73 patients (34%) had an atypical clinical presentation (i.e. no chest pain). A total of 29 (13.5%) patients died within 30 days of the index hospitalization. Higher Cumulative Illness Rating Score‐Geriatric severity index score (P = 0.019) and initial atrial fibrillation (P = 0.022) were predictive of 30‐day all‐cause mortality. Typical presentation (P = 0.010) was a protective factor of 30‐day all‐cause mortality. A Cumulative Illness Rating Score for Geriatrics total score increase (P = 0.0003) and residing in a nursing home (P = 0.024) emerged as independent risk factors for atypical presentation. Conclusions In “real‐life” elderly patients, comorbidities influence the prognosis of myocardial infarction, but also clinical presentation. Identification of patients at risk of atypical presentation; that is, patients with multiple comorbid conditions, might help refine the prognostic value in older patients with myocardial infarction. Geriatr Gerontol Int 2018; 18: 1591–1596.

Des troubles cognitifs, notamment exécutifs, ont pu être retrouvés chez des patients avec une broncho-pneumopathie chronique obstructive (BPCO), même en l'absence d'hypoxémie. L'objectif de cette étude descriptive était de rechercher une atteinte des fonctions exécutives, plus particulièrement de la flexibilité mentale, chez sujets BPCO non oxyéno-dépendants. Les patients ont été inclus à partir de la base de données d'un centre mémoire de gériatrie. Trente et un patients avec BPCO ont été inclus (85 ± 6 ans) dont 7 ayant une maladie d'Alzheimer (MA) et 11 des troubles cognitifs mineurs (TCm). Ils ont été appariés à des patients contrôles sans BPCO. On ne notait pas de différence significative entre les deux groupes, même si les temps de réalisation étaient augmentés dans le groupe BPCO : en moyenne de 13 secondes pour le TMTA et de 18 secondes pour le TMTB pour le groupe TCm et de 63 secondes et de 97 secondes pour le groupe MA. L'allongement des temps de réalisation du TMT pourrait représenter une piste intéressante pour explorer une atteinte cognitive liée à la BPCO. Une étude incluant un nombre suffisant de patients est nécessaire pour confirmer ce résultat.

Data on octogenarian patients with MM are scarce, and optimal management remains controversial. We report a retrospective cohort of unselected octogenarian patients with NDMM treated with bortezomib dexamethasone (Vd). Seventy-four patients were treated with an initial doublet therapy (Vd regimen, 2–3 cycles, induction). A dose escalation with an adjunction of melphalan or cyclophosphamide was proposed for patients who had an insufficient response after induction and who could tolerate it. In responders, the treatment was continued until progression or a plateau response for 6 months (consolidation). The overall response rate was 73%. After a median follow-up of 31.4 months, median progression-free survival (PFS) and overall survival (OS) were 13.2 and 26.9 months, respectively. PFS and OS of patients with ECOG PS < 3 (25.4 and 54.9 months, respectively) were better in comparison to PFS and OS of patients with ECOG PS > 3 (9.3 and 11.3 months, respectively). Thirteen patients (17.6%) died during induction. Twelve patients (16.2%) died during consolidation. In conclusion, a conservative therapeutic strategy based on Vd resulted in a good response rate. However, the survival remains poor in the population of patients with an ECOG PS > 3, mainly because of early mortality not related to progressive disease.