ABSTRACT
BACKGROUND: ST elevation myocardial infarction (STEMI) in old and old-old patients presents several peculiarities in natural history, delay of hospitalization and response to treatment. Aim of this retrospective case control study was to determine presentation, complications and management of elderly patients with STEMI compared to a younger population. METHODS: 462 patients (205 M and 257 F) aged > or =75 years, hospitalized in CCU between 1999 and 2003 for STEMI, were evaluated. The control group consisted of 490 consecutive patients (268 M and 222 F) aged 50-70 years. Attention was focused on clinical presentation, complications, management and outcome in elderly compared with younger patients. RESULTS: The mean interval between the onset of symptoms and the arrive in CCU was of 9 hour in the elderly compared to 4,5 hour in the control. Chest pain was less frequent (50% vs 90%) in the elderly; the prevalence of dyspnoea and neurological symptoms was higher in patients >75 years (30% vs. 15% and 25% vs. 10%). In the elderly, previous angina and AMI, cerebral and peripheral vascular diseases, peripheral and renal failure were frequent. Early severe complications prevailed in the elderly. Thrombolysis was performed only in 39% of the elderly compared to 65% of the control. Significantly higher was cerebral haemorrhage after thrombolysis (4.9% vs. 1.8%). Comparable were the mayor extra cranial bleedings. Primary or facilitated PTCA was performed in few patients in the last year. Two weeks mortality was 20%, compared to 6.5% in the control group. CONCLUSION: The patients >75 years with STEMI were hospitalized later, had atypical presentation with less chest pain and more cardiac failure, were less likely to receive thrombolysis, had more complications and more cerebral bleedings. Elderly had more associated diseases and in-hospital mortality was higher.
Subject(s)
Aging , Heart Conduction System/physiopathology , Myocardial Infarction/diagnosis , Aged , Aged, 80 and over , Angioplasty, Balloon, Coronary , Case-Control Studies , Electrocardiography , Evaluation Studies as Topic , Female , Fibrinolytic Agents/adverse effects , Fibrinolytic Agents/therapeutic use , Hospitalization/statistics & numerical data , Humans , Italy , Male , Middle Aged , Myocardial Infarction/complications , Myocardial Infarction/mortality , Myocardial Infarction/physiopathology , Myocardial Infarction/therapy , Retrospective Studies , Risk Factors , Survival AnalysisABSTRACT
The clinical outcome of 48 consective patients with myocardial infarction who received tirofiban for unsuccessful thrombolysis was compared with that of 48 patients matched for age, gender, and infarct location who did not receive rescue treatment. Those who received tirofiban had more successful reperfusions, and there were few bleeding complications.
Subject(s)
Fibrinolytic Agents/therapeutic use , Myocardial Infarction/drug therapy , Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors , Thrombolytic Therapy , Tissue Plasminogen Activator/therapeutic use , Tyrosine/analogs & derivatives , Tyrosine/therapeutic use , Aged , Feasibility Studies , Female , Humans , Male , Middle Aged , Retreatment/methods , Tirofiban , Treatment FailureABSTRACT
Spontaneous coronary dissection is responsible for acute coronary syndromes particularly in females during and in the peri-partum period. It rarely occurs in patients without atherosclerotic coronary plaques. We report a particular clinical course of a 39-year-old patient with spontaneous dissection of two coronary arteries. His clinical course suggested only medical treatment, with aspirin, beta-blockers and ACE-inhibitors. At 3 months of follow-up the patient is free of symptoms.