Clinical Characteristic Of Acute Myocardial Infarction In Elder Groups

Objective: To explore and discuss about the features of elderly patients with acute myocardial infarction(AMI) through the comparison of difference in cardiovascular risk factors, laboratory index, treatment strategy, vasculopathy, complications,intra-hospital ending between the elderly AMI patients and the young AMI patients and middle-aged AMI patients, so as to provide a targeted therapy for the elderly AMI patients and a potential basis for the prevention.Methods: The data of 776 cases of AMI patient in total diagnosed and treated in department of cardiology of affiliated hospital of ZUNYI medical college from Jan,2011 to Dec, 2015 was retrospectively collected, the patients were divided into three groups based on age, 100 cases for youth group(<45 years-old), 399 cases for middle-aged group(45-64 years-old), 277 cases for elderly group(≥65 years-old).The features of Elderly patients with acute myocardial infarction(AMI) were analyzed through the comparison of difference in cardiovascular risk factors, laboratory index,treatment strategy, vasculopathy, complications, intra-hospital ending between the elderly AMI patients and the young AMI patients and middle-aged AMI patients,meanwhile, the intra-hospital death of elderly AMI patient was analyzed by a Logistic regression analysis to determine the independent risk factor of death of elderlygroup.Results:(1)The percentage of female in the elderly group was higher than that of youth group and middle-aged group(P<0.001), the percentage of hypertension of elderly group was higher than that of middle aged group(P<0.001). The percentage of smoking and dyslipidemia was lower than that of youth group and middle-aged group(P<0.001). The degree of pulmonary venous pleonaemia(Killip Ⅱ-Ⅳgrade)of elderly group was higher than that of middle aged group(P=0.007).(2)The elderly group was significantly lower than youth group and middle aged group in terms of the percentage of sinus rhythm of electrocardiogram(P<0.001; P<0.001).The elderly group was significantly higher than middle aged group in terms of the percentage of atrioventricular block(P=0.004), the elderly group was significantly higher than youth group and middle aged group in terms of the percentage of atrial fibrillation, ventricular fibrillation/ventricular tachycardia.(3)The TG, TC and LDL-C of elderly group was significantly lower than the serum level of youth group and middle aged group(P<0.05), while in terms of the level of APOA1 and APOB, the elderly group was significantly higher than youth group and middle aged group(P<0.05), in terms of serum level of HDL-C, only the HDL-C level of elderly group was significantly higher than that of middle aged group(P=0.003).(4)The percentage of patients in elderly group who were performed with emergency PCI was significantly lower than that of middle aged group(P=0.018), while in terms of the percentage of the patients’ family members who declined the surgery for the patients hospitalized,the elderly group was significantly higher than the middle aged group(P=0.021). the elderly group was significantly lower than youth group and middle aged group in terms of percentage of single-vessel lesion(P<0.00; P=1 0.003), while in terms of double vessel and triple vessel lesion, the elderly group was significantly higher than youth group(P<0.001). The elderly group was significantly shorter than youth group in terms of the diameter of support(P<0.001), the elderly group was significantly lower than youth group in terms of percentage of occurrence of thrombus and implantation of temporary pacemaker(P=0.003; P<0.001), while in terms of percentage of occurrence of intraoperative hypotension, the elderly group was higher than youth group(P<0.001). The elderly group was significantly higher than youth group in terms of the use of furosemidum and spirolactone(P=0.008; P=0.011).(5)It was shown by the regression analysis on relevant risk factors of intra-hospital death of elderly group that, the ventricular fibrillation/ventricular tachycardia and conservative therapy were the independent risk factors of death of elderly group.Conclusion:(1)The ratios of male, smokers and patients with dyslipidemia in the elderly group were lower than those of the youth and middle aged group, while the percentages of patients with high blood pressure, atrial and ventricular fibrillation were higher than those of the youth group, and the portion of Killip > I,atrioventricular block were higher than those of the middle aged group.(2)A higher percentage of patients in the elderly group rejected to reperfusion treatment than that of the middle aged group. The age of the patients had no effect on the success rate of operation.(3)Double vessel and multiple vessel lesion were mainly occurred in the old age group,and this coronary artery occlusion to a larger extent was caused by the gradual pathological changes of atherosclerosis which might be attributed to the rate of high blood pressure in elderly group.Single vessel lesion majorly occurred in youth group, and the reason of coronary artery occlusion might be thrombus which might be associated with smoking and dyslipidemia.(4)The hospital mortality rate of elderly group was apparently higher than that of the youth and middle aged group respectively. The Logistic regression analysis on the mortality rate of elderly group showed that ventricular fibrillation / ventricular tachycardia and conservative therapy were the independent risk factors for the death of elderly group.