OUTLOOK AFTER ACUTE MYOCARDIAL-INFARCTION IN THE VERY ELDERLY COMPARED WITH THAT IN PATIENTS AGED 65 TO 75 YEARS

Little is known concerning late outcome and prognostic factors after acute myocardial infarction in the very elderly (>75 years of age). Accordingly, this study compared the clinical course and mortality rate for up to 1 year in a large multicenter data base that included 702 patients >75 years of age (mean ± SD 81 ± 4 years), with a less elderly subset of 1,321 patients between 65 and 75 years of age (mean 70 ± 3 years). The postdischarge 1 year cardiac mortality rate was 17.6% for those >75 years of age compared with 12.0% for patients between 65 and 75 years of age (p < 0.01). There were differences in the prevalence of several factors, including female gender, history of angina pectoris, history of congestive heart failure, smoking habits and incidence of congestive heart failure during hospitalization. Multivariate analyses of predictors of cardiac death in hospital survivors selected different factors as important in the two age subgroups; age was selected in the 65 to 75 year age group but was not an independent predictor in the very elderly. The survival curves beginning at day 10 for patients 65 to 75 and in those >75 years old were similar for up to 90 days but diverged later. In the very elderly, 63% of late cardiac deaths were sudden or due to new myocardial infarction, similar to the causes of 67% of deaths in the younger age group. The findings that death is delayed and appears to be primarily due to an ischemic event or sudden death suggest that in the convalescent phase after acute myocardial infarction noninvasive studies currently applied in a significant number of patients 65 to 75 years of age could also be used to identify high risk patients >75 years of age suitable (in the absence of other major medical problems) for coronary angiography and possible revascularization therapy. © 1990, American College of Cardiology Foundation. All rights reserved.