MYOCARDIAL, INFARCTION IN SUBJECTS OVER 7 5 YEARS OF AGE

Objectives: Analyse management of myocardial infarction in elderly sub jects and assess long-term outcome, Methods: We studied retrospectivel y a series of 151 consecutive cases of acute myocardial infarction in patients over 75 gears of age and compared then with a group of young subjects under 65 years of age admitted for the same pathology during the same period (1989-1993). Results: In the elderly population, femal e sex, past history of angina or infarction, atypical presentation and hemodynamic complications were more frequent in the elderly populatio n (left ventricle failure 44 vs 13%, cardiogenic shock 17.2 vs 0.7% wi thout any difference in localization. Mortality was higher in the elde rly group (23.2 vs 2.6%) with 68.6% of the deaths due to primary cardi ogenic shock. Beta-blockers were used less frequently in the elderly p opulation (31.8 vs 83.0%) as was thrombolysis (26.5 vs 64.5%); coronog raphy was performed less often (21.8 vs 92.7%) as was percutaneous rev ascularization (9.9 vs 36.4%) or surgery (1.3 vs 6.6%), Survival at 1, 2 and 5 years was 88, 76 and 57% in the elderly group (Kaplan-Meier p lot). A past history of unstable angina and a critical episode of: lef t ventricle failure were factors predicting overmortality. Conclusion: Acute myocardial infarction, remains a severe condition in patients o ver 75 pears of age with overmortality during hospitalization and poor long-term prognosis, Clinical signs of poor prognosis could help guid e selection for more aggresive therapeutic management during the post- infarction period, notably in terms of coronary revascularization.