Republican Specialized Center of Cardiology, Tashkent, Uzbekistan
*Corresponding author: Aleksey G. Nikishin, PhD, Department of Acute Myocardial Infarction, Republican Specialized Center of Cardiology, 4, Osiyo str., 100052, Tashkent, Uzbekistan. Tel.: 998-97-119-6133. E-mail: email@example.com
Background: To detect distinctive features of the clinical course for acute myocardial infarction (AMI), treatment tactics, and clinical outcomes in elderly patients of the Central Asian region.
Methods: The study included 508 patients who were assigned into two groups: Group 1 consisting of patients older than 65 years of age with AMI and Group 2 consisting of those younger than 65 years. The mean time from AMI onset to hospital admission was studied, as well as the number of patients admitted during the first 6 hours after onset, the number of patients treated with streptokinase and its efficacy, clinical course of AMI, and in-hospital outcomes.
Results: The mean time for hospital admission in the group of patients older than 65 years was significantly longer than in the control group: 1220±165 min versus 977±88 min (p<0.05). Out of 188 patients with ST segment elevation who were older than 65 years, only 14.3% received streptokinase compared to 25.5% in the control group where 149 patients had ST segment elevation. The clinical picture of AMI in both the study groups did not differ significantly. The groups were reliably distinguished by in-hospital mortality (9.4% against 2.86%; p=0.001; odds ratio (OR) 3.53 (1.43-8.67)), frequency of acute heart failure occurrence (33.89% versus 21.9%; p=0.001; OR 1.83 (1.22-2.74), and chronic heart failure development (41.31% versus 24.76%; p=0.000; OR 2.62 (1.78-3.86)).
Conclusion: The main problem in elderly patients is a lower probability in achieving myocardial reperfusion (due to delay in seeking medical help and lower efficacy of thrombolytic therapy) and a higher occurrence of heart failure as a result.
- Rathore SS, Berger AK, Weinfurt KP, Feinleib M, Oetgen WJ, Gersh BJ, Schulman KA. Race, sex, poverty, and the medical treatment of acute myocardial infarction in the elderly. Circulation 2000; 102(6):642-8.
- Avezum A, Makdisse M, Spencer F, Gore JM, Fox KA, Montalescot G, Eagle KA, White K, Mehta RH, Knobel E, Collet JP. Impact of age on management and outcome of acute coronary syndrome: observations from the Global Registry of Acute Coronary Events (GRACE). Am Heart J 2005;149(1):67-73.
- Brieger D, Eagle KA, Goodman SG , et al. GRACE Investigators. Acute coronary syndromes without chest pain, an under diagnosed and under treated high-risk group: Insights from the Global Registry of Acute Coronary Events. Chest 2004; 126:461–69.
- De Servi S, Cavallini C, Dellavalle A. Non-ST-elevation acute coronary syndrome in the elderly: Treatment strategies and 30-day outcome The American heart journal 2004;147:830-6
- Gersh BJ, Sliwa C, Mayosi DM, Yusuf S. The epidemic of cardiovascular disease in the developing world: global implications Eur. Heart J 2010; 31: 642-648
- George E, Savitha D, Pais P. Pre-hospital issues in acute myocardial infarction. J Assoc Physicians India 2001; 49: 320–3.
- Joshi P, Islam S, Pais P, et al. Risk Factors for Early Myocardial Infarction in South Asians Compared With Individuals in Other Countries. JAMA 2007; 297 (3):286-94
- Malhotra S, Gupta M, Chandra KK, et al. Prehospital delay in patients hospitalized with acute myocardial infarction in the emergency unit of a north Indian tertiary care hospital. Indian Heart J 2003; 55: 349–53.
- The future of CVD. In: Mackay J, Mensah G, eds. The Atlas of Heart Disease and Stroke. Geneva, Switzerland: World Health Organization; 2004; 74–75.
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