Comparison of clinical presentations and outcomes between adult and elderly acute myocardial infarction patients in emergency department

Po-Hua Su, Pang-Yen Chen, Shih-Yi Lee, Chorng-Kuang How, Ding-Kuo Chien, Wen-Han Chang


Background: Acute myocardial infarction (AMI) is one of a leading cause of death. The clinical presentations and outcomes between adults and elderly were still not well established.
Methods: We conducted a prospective study to evaluate the clinical manifestations of AMI at emergency department in Taiwan. Patients with unstable angina were excluded. The primary endpoint was all-cause mortality. The inpatient days, discharge activities, complications were collected for comparisons.
Results: Overall 210 consecutive cases with acute coronary syndrome were recruited in ER, 202 patients with AMI were enrolled for further analysis (66.3% STEMI and 33.7% NSTEMI). Among all AMI patients, 57 patients (28.2%) aged more than 65 years old. The overall inpatient days and total complications were not significantly different between adult and elderly patients. However, K-M survival analysis displayed that patients over the age of 75 years old was with poor event free survival rate of mortality (Log-rank test, P=0.03), especially for those patients with STEMI (Log-rank test, P=0.01). Cox regression exhibited that chest X-ray finding of cardiomegaly [adjusted hazard ratio (HR), 95% confidence interval (CI): 13.5, 1.27–144, P=0.03] and peak CK-MB levels (adjusted HR, 95% CI: 1.003, 1.001–1.004, P<0.001) were independent risk factors in predicting future mortality for all AMI patients.
Conclusions: The clinical presentations and outcomes may vary among adult AMI patients and older AMI patients. The chest X-ray finding of cardiomegaly and higher peak CK-MB levels may predict future mortality in AMI patients. The elderly patients over 75 years were with higher mortality after onset of AMI.