Determinants of clinical presentation on outcomes in older patients with myocardial infarction

Abstract

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.

Prognostic Significance of Biomarkers in Predicting in-Hospital All-Cause Mortality in Elderly Patients with Acute Myocardial Infarction

“…This work is one in a few studies focusing on risk assessing only in elderly and very elderly patients during AMI. Our study showed a significant association between selected biomarkers and cardiac mortality during the hospital stay, which was similar to other authors' results [19][20][21]. Levels of all biomarkers were higher in non-surviving patients after AMI.…”

Potentially Inappropriate Medication Use in Older Adults in the Preoperative Period: A Retrospective Study of a Noncardiac Surgery Cohort

“…In our study, the vulnerable and frail populations had more PIMs than the robust group even when the disease burden, as measured by the Charlson comorbidity score, was comparable. Presentation of illness differs between older and younger adults, with older patients showing more atypical signs and symptoms, potentially requiring more medication and therefore having an increased pill burden [21][22][23]. Unusual symptoms might result in more prescriptions and, indeed, probably more PIMs.…”

Atypical Presentation of Bacteremia in Older Patients Is a Risk Factor for Death

“…The only factors associated with atypical clinical signs in our study were diabetes and infection with S. aureus. Diabetes is a known risk factor for atypical manifestation of myocardial infarction (without chest pain) (34) and asymptomatic bacteriuria. Diabetic patients are also more susceptible to S. aureus colonization (35) and bacteremia (36).…”