Difficulties of diagnostics of acute myocardial infarction in elderly and senile patients and their influence on management in the acute period of disease

Abstract

Aim. To study the features of disease progress and approaches to the diagnostics of acute myocardial infarction (MI) among elderly and senile patients and their influence on the management in the acute period of disease.Materials and methods. The study was performed using the WHO program “Register of acute myocardial infarction” (Tomsk). The study included 410 patients (60 years and older), who had acute MI. The study group is represented by a comparable number of men (n=212) and women (n=198). The mean age of patients was 71 (66; 77) years (women are 5 years older than men (p<0,001)). Statistical processing was performed using the program Statistica V10.0.Results. Most of the patients had history comorbid pathology. In one in five patients (17,8%), the disease had an atypical manifestations, which in 41% of cases was represented by the asymptomatic form. Atypical manifestation of MI lengthened the prehospital phase of medical care due to a longer time before the first medical contact (p=0,005), as well as a late help-seeking (120 [49; 311,5] minutes). In 28% of patients, the level of creatine kinase-MB remained normal, and the indicator of troponin I exceeded the maximum values only in half of the cases. One fifth of the patients underwent acute MI treatment in non-core hospitals, which resulted in a low frequency of intervention (38%) and increasing by 2 times the chance of death within 5 years. The level of hospital mortality from acute MI in elderly patients in noncore hospitals was 3 times higher than in specialized departments (p<0,001).Conclusion. Difficulties in diagnostics of MI in patients of older age groups is caused by the prevalence of comorbid pathology, an atypical manifestations of the disease and low information content of biochemical markers of myocardial necrosis. It leads to an increase in time delays at the prehospital phase and frequent hospitalization of patients in non-core hospitals, making it impossible for them to receive timely, preferred therapy.

Longevity and frailty and their associated factors in the prognosis of coronary heart disease in a Latin American cohort

“…Furthermore, the absence of classic manifestations of a coronary accident makes the diagnosis of myocardial infarction difficult in the prehospital stage , also increasing hospitalization time and increasing mortality rates [12▪ ] . For the same reason, patients with unexpressed and "non-classical" symptoms in 20% of cases are hospitalized in general medical and surgical hospitals, which, undoubtedly, cannot but affect the prognosis of the disease, taking into account the lack of possibility of timely myocardial revascularization [ 13] .…”

“…forms of acute myocardial infarction [4] [5] . It should also be taken into account that elderly and senile people often suffer from various psychoneurological disorders , accompanied by a distortion of patients' perception of the symptoms of coronary heart disease, which leads to an underestimation of its severity [6] [7 ].…”

Prediction of in-hospital mortality in patients aged 75 years and older with acute ST-segment elevation myocardial infarction using logistic regression and classification tree

“…В настоящее время госпитальная летальность пациентов с ИМпST ЭКГ в странах Европы составляет 6-14% [3,4], в РФ -10,7-13,5% [5,6]. Вместе с тем среди пациентов пожилого и старческого возраста госпитальная летальность от ИМ без разделения на ИМпST ЭКГ и ИМ без подъема сегмента ST ЭКГ остается высокой и составляет 27,8% [7], а для долгожите-лей, из которых в цитируемой работе 42,7% пациенты с ИМпST ЭКГ, -40,2% [8].…”

“…Возможными причинами высокой летальности пациентов в возрасте ≥75 лет являются отягощенный сердечно-сосудистый анамнез, высокая распространенность коморбидной патологии, которые затрудняют диагностику и лечение текущего ИМ [7], наличие старческой астении, неоправданный отказ от проведения чрескожного коронарного вмешательства (ЧКВ) и другие.…”