GERIATRIC-PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION - CARDIAC RISK FACTOR PROFILES, PRESENTATION, THROMBOLYSIS, CORONARY INTERVENTIONS, ANDPROGNOSIS

Elderly patients have a higher mortality after acute myocardial infarc tion (MI) yet are treated less aggressively than younger patients, To determine (1) the risk-factor profiles, (2) presentation, (3) manageme nt, and (4) hospital outcomes for the elderly (greater than or equal t o 75 years) compared with middle aged (66 to 74 years) and younger (le ss than or equal to 65 years) patients in the 1990s, we studied 561 co nsecutive patients with acute MI, Compared with younger patients, the elderly more frequently had congestive heart failure (40% vs 14%; p < 0.00001) and non-Q wave infarctions (76% vs 56%; p < 0.005), received thrombolysis (9% vs 34%; p < 0.0001), and underwent catheterization (3 5% vs 73%; p < 0.00001), percutaneous transluminal coronary angioplast y (9% vs 31%; p < 0.0002), and coronary artery bypass grafting (5% vs 15%; p < 0.03) less frequently, Those who did not receive thrombolysis all had contraindications, Mortality was higher in the elderly (19% v s 5%; p < 0.004), especially among those who did not receive thromboly sis (20% vs 7%; p < 0.03), Multivariate predictors of mortality includ ed age, and congestive heart failure, In addition, when clinical cours e and management variables were considered, use of the intraaortic bal loon pump was a predictor of mortality, whereas undergoing coronary an giography was a negative predictor (relative risk, 0.3; 95% confidence intervals, 0.1 to 0.6).