Influence of age on clinical course, management and mortality of acute myocardial infarction in the Spanish population

Ruiz-Bailén, Manuel; Hoyos, Eduardo Aguayo de; Ramos-Cuadra, José Ángel; Díaz-Castellanos, Miguel Ángel; Issa-Khozouz, Ziad; Reina-Toral, Antonio; López-Martı́nez, Asunción; Calatrava-López, Jesús; Laynez-Bretones, Francisco; Castillo-Parra, Juan Carlos; Torre-Prados, M. V. de la

doi:10.1016/s0167-5273(02)00187-0

Cited by 36 publications

(20 citation statements)

References 16 publications

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“…The present study is a 'real world' survey for AMI, as defi ned by consensus document issued by ESC/ACC [17] , in which we observed a higher prevalence of certain comorbid conditions such as diabetes, history of AMI, and stroke in elderly patients. The incidence of diabetes in very elderly patients is in agreement with previous studies [12,13] . Nevertheless, the lower incidence of prior CABG or PTCA in older patients may indicate a survivor effect, but it may alternatively represent historical practice patterns of fewer coronary interventions.…”

Section: Discussionsupporting

confidence: 92%

“…As reported in other studies, there was an increase in the proportion of female patients with increasing age [12,13] . Previous research has found that older age is associated with a higher prevalence of comorbid conditions, atypical AMI presentation, non-diagnostic electrocardiograms, complications and mortality [2, 5-7, 10, 12-16] .…”

Section: Discussionsupporting

confidence: 85%

“…A role may be played by the reluctance of physicians to admit older patients. Although the present study found a reduction in the use of thrombolysis in older patients, particularly in the very elderly, thrombolysis use was higher in our setting than that reported by Mehta et al [12] but lower than in those described by Ruiz-Bailén et al [13] . Analysis of the baseline characteristics of reperfused patients shows that overall older patients have fewer cardiovascular risk factors than the younger ones.…”

Section: Discussioncontrasting

confidence: 83%

“…Indeed, the pre-hospital delay for very elderly patients was longer, with a time delay of pre-hospital management greater in the very elderly group. Our results show that patients from the elderly group have shorter pre-hospital delays than younger and very elderly groups while previous studies have shown that the older the patient is the longer the pre-hospital delay [13] . There are various possible explanations.…”

Section: Discussioncontrasting

confidence: 55%

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Factors Affecting the Management of Outcome in Elderly Patients with Acute Myocardial Infarction Particularly with Regard to Reperfusion

Popitean

Barthez²,

Rioufol³

et al. 2005

Gerontology

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Background: Acute myocardial infarction (AMI) in elderly patients is often unrecognized and associated with poor prognosis. Objectives: To investigate management and efficacy of reperfusion therapy to the elderly patients with AMI. Methods: From the January 1, 2001 to October 31, 2002, 964 patients with AMI were included in the French regional RICO survey. The patients were divided into three groups: younger (<70 years old), elderly (70–79 years old) and very elderly (≧80 years old). Results: Distribution of groups was 56, 27, and 16%, respectively. The longest time delay to first request for medical attention was found in the very elderly group (30 and 55 vs. 90 min, respectively, p < 0.05). Rate of lysis fell significantly with increasing age (35, 22 and 9%, respectively, p < 0.001) but the time delay to lysis was similar for the 3 groups. The proportion of patients who benefited from primary percutaneaous transluminal coronary angioplasty decreased with age (21, 15, 11%, respectively, p < 0.001), but time delay to balloon angioplasty was similar and no difference in mortality rate was observed between the three groups after reperfusion. The incidence of in-hospital cardiovascular events (cardiogenic shock and recurrent myocardial infarction/ischemia) and in-hospital mortality increased with age (5, 13, 17%, respectively, p < 0.001). Moreover, multivariate analysis showed that only ejection fraction and Killip >1 were independent predictive factors for in-hospital cardiovascular mortality, respectively (OR 5.15, 95% CI 2.08–12.74, p < 0.0001 and OR 3.81, 95% CI 1.90–7.65, p < 0.0001), whereas age, sex, diabetes and anterior location were not significant. Conclusion: Our data in an unselected population indicate that very elderly patients were characterized by increased pre-hospital delays and less frequent utilization of reperfusion therapy, although no difference in the mortality in reperfused patients could be observed between the three age groups.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 85%

Section: Discussioncontrasting

confidence: 83%

Section: Discussioncontrasting

confidence: 55%

See 2 more Smart Citations

Factors Affecting the Management of Outcome in Elderly Patients with Acute Myocardial Infarction Particularly with Regard to Reperfusion

Popitean

Barthez²,

Rioufol³

et al. 2005

Gerontology

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“…However, comparative studies of such subgroups are limited, and the size of the study sample is small. The objective of the present study is to evaluate by the objective method of cosinor analysis (Alberola- López & Martin-Fernández, 2003) the presence of circadian variation in the onset time of AMI, in general and in subgroups of cases, using a large database of a multicenter study involving 119 Spanish hospitals (Alvarez-Bueno et al, 1999;Aguayo de Hoyos et al, 2001;Lopez-Messa et al, 1999, 2001Saturno et al, 2000), where the efficacy of thrombolysis and the influence of age on the clinical course and mortality has already been described , 2002.…”

Section: Introductionmentioning

confidence: 99%

New Insights into the Circadian Rhythm of Acute Myocardial Infarction in Subgroups

Leiza¹,

Llano²,

Messa³

et al. 2007

Chronobiology International

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The aim of this study was to determine the existence of the circadian rhythm (CR) in the onset of acute myocardial infarction (AMI) in different patient subgroups. Information was collected about 41,244 infarctions from the database of the ARIAM (Analysis of Delay in AMI) Spanish multicenter study. CR in AMI were explored in subgroups of cases categorized by age, gender, previous ischemic heart disease (PIHD), outcome in coronary care unit, infarction electrocardiograph (ECG) characteristics (Q wave or non-Q wave), and location of AMI. Cases were classified according to these variables in the different subgroups. To verify the presence of CR, a simple test of equality of time series based on the multiple-sinusoid (24, 12, and 8 h periods) cosinor analysis was developed. For the groups as a whole, the time of pain onset as an indicator of the AMI occurrence showed a CR (p<0.0001), with a morning peak at 10:10 h. All the analyzed subgroups also showed CR. Comparison between subgroups showed significant differences in the PIHD (p<0.01) and infarction ECG characteristics (p<0.01) groups. The CR of the subgroup with Q-wave infarction differed from that of non-Q wave subgroup (p<0.01) when the patients had PIHD (23% in Q wave infarction vs. 39.2% in non-Q wave). AMI onset followed a CR pattern, which is also observed in all analyzed subgroups. Differences in the CR according to the Q/non-Q wave infarction characteristics could be determined by PIHD. The cosinor model fit with three components (24, 12, and 8 h periods) showed a higher sensitivity than the single 24 h period analysis.

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Acute Coronary Syndrome:NSTEMI

2006

Wiley Handbook of Current and Emerging Drug Therapies

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Influence of age on clinical course, management and mortality of acute myocardial infarction in the Spanish population

Cited by 36 publications

References 16 publications

Factors Affecting the Management of Outcome in Elderly Patients with Acute Myocardial Infarction Particularly with Regard to Reperfusion

Factors Affecting the Management of Outcome in Elderly Patients with Acute Myocardial Infarction Particularly with Regard to Reperfusion

New Insights into the Circadian Rhythm of Acute Myocardial Infarction in Subgroups

Acute Coronary Syndrome:NSTEMI

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