Infarto agudo al miocardio en octogenarios, caracterización y comparación con pacientes menores en 20 años de registro

Autores/as

  • Héctor Ugalde P. Hospital Clínico Universidad de Chile. Departamento Cardiovascular
  • Maria Ignacia Sanhueza F. Universidad de Chile
  • María Cecilia Yubini L. Universidad de Chile
  • Sebastián Rozas A. Universidad de Chile

Resumen

Introduction: cardiovascular diseases are the main cause of death in Chile, being acute myocardial infarction (AMI) the most frequent. Its incidence increases with age, so, as the population gets older; a higher number of cases is expected. Despite this, AMI within octogenarian patients (OP) has been understudied in our country and worldwide; there are no specific guidelines for their management, only a few isolated studies that reveal the poor applicability of the standard treatments indicated in AMI clinical guidelines. Objective: To describe the clinical features, initial treatment, in-hospital evolution and five-year outcome of OP with AMI, and compare them to patients under 80 years of age. Method: Consecutive registration of all patients diagnosed with AMI that were hospitalized in our coronary unit between 1988 and 2007. Description of clinical features, in-hospital and 5-year evolution of all OP cases. Comparison to the younger group of patients through chi-square or t-student tests, considering p-value <0.05 as statistically significant. Results: 1851 AMI patients were registered within this period, of which 135 (7,3%) were OP. The mean age was 83,7 years (80-100), 59% chronic hypertension, 22% diabetes, 11% smokers, 44% had history of angina and 13% previous AMI. The mean evolution time was 10 hours (80% <12 hours), 67% had ST- segment elevation (STE), 56% anterior-wall AMI. 29% underwent reperfusion therapy, and 64% presented AMI complications, mainly cardiac insufficiency. Coronarography was performed to 42% of OP, 33% were revascularized. In-hospital mortality was 29%, mainly because of cardiac insufficiency, 5-year mortality was 52.1%. Compared to younger patients, OP account for more female cases, higher Killip-scores, less STE-AMI, receive less reperfusion therapy and early beta-blockers, have more complications, are less studied and revascularized, and have higher mortality rates. Conclusion: OP have initial characteristics that configure greater severity to AMI. Besides, they are treated more conservatively, having a worse in-hospital evolution along with higher early and 5-year mortality. We suggest that this conservative behavior accounts for an important part of the unfavorable outcomes among OP, according to the few international studies available on this topic.

Palabras clave:

Infarto del Miocardio, Salud del Anciano