Risk Factors And Clinical Characteristics Of Elderly Aged Patients With Acute Myocardial Infarction

BackgroundAs there are many complications in the elderly aged patients with myocardial infarction,and the complex medical history affects the prognosis of the disease itself,many large clinical randomized controlled trials exclude the elderly aged population.The clinical evidence leading to myocardial infarction in the elderly aged patients is obviously insufficient.And some preliminary studies have found that the risk factors of elderly aged AMI patients are also significantly different from those of the middle-aged AMI patients,so it is necessary to further study the risk factors and clinical characteristics of AMI in the elderly aged patients.ObjectiveTo retrospectively analyze the medical records of elderly aged AMI patients,and to compare the risk factors and clinical characteristics of elderly aegd AMI patients,elderly AMI patients and middle-aged AMI patients,so as to provide more clinical evidence for myocardial infarction in the elderly aged patients.MethodsA total of 593 patients with acute myocardial infarction in the Department of Cardiology of the first affiliated Hospital of Soochow University from August 2017 to August 2019 were collected.According to their age,they were divided into three groups:elderly aged group(n=165),elderly group(n=174)and middle-aged group(n=254).Basic data,past history,laboratory indexes,results of coronary angiography and the occurrence of complications or major adverse cardiovascular events(MACE)during hospitalization were collected.At the same time,265 healthy subjects whose sex and age(±2 years old)1:1 matched with the very elderly myocardial infarction group were selected as the elderly aged non-AMI group.Collect their basic data,past history and laboratory examination indicators.T-test or nonparametric test was used in the continuous variable between the two groups,chi-square test was used to the categorical variable,and conditional Logistic regression was used to analyze the risk factors of the elderly aged group.The data of this study were analyzed by SPSS22.0 software,and the difference was considered to be statistically significant when P<0.05ResultsIn this study,the proportion of males in middle-aged,elderly and elderly aged patients with AMI was 95.3%,70.1%and 61.8%,respectively.The proportion of smoking,overweight/obesity and hyperlipidemia in the middle-aged group was higher than that in the elderly aged group(75.2%vs 33.3%,44.9%vs 18.2%,47.6%vs 23.6%).The proportion of hypertension and diabetes in the elderly aged group was higher than that in the middle-aged group(77.0%vs 42.1%,39.4%vs 17.7%).Logistic regression showed that diabetes,LDL-C and smoking were independent risk factors of myocardial infarction in the elderly aged patients,while HDL-C was a protective factor.63.4%of the elderly aged patients with myocardial infarction were associated with 2 or more controllable risk factors.The proportion of chest pain in the elderly aged group was significantly lower than that in the elderly group and the middle-aged group(53.3%,65.5%,80.7%),and the proportion of atypical symptoms was higher.Compared with the elderly group,the levels of Hb,platelet count,TG,TC,LDL-C,eGFR and LVEF were lower,while the levels of HDL-C,creatinine and uric acid were higher in the elderly aged group.Compared with elderly group,the proportion of using aspirin,ticagrelor,?-receptor blockers and GP? b/?a inhibitors in the elderly aged AMI patients during hospitalization was lower,while the proportion of using clopidigrel was higher,with significant statistical differences.The proportion of CAG and PCI during hospitalization in the elderly aged AMI group was significantly lower than that in the elderly AMI group and the middle-aged group.The results of coronary angiography showed that the proportion of single-vessel lesions in the middle-aged group was higher than that in the elderly aged AMI group,while the proportion of multi-vessel lesions in the middle-aged group was lower than that in the elderly aged group.The anterior descending branch was the most common among the three groups,and the proportion of calcified lesions in the elderly aged group was higher than that in the elderly group(P=0.02).Binary Logistic regression showed that diabetes was the most significant risk factor for multivessel disease(OR=2.089,95%CI1.295-3.370),followed by hypertension(OR=1.890,95%CI1.071-3.333).For the revascularization of multi-vessel disease,the proportion of culprit-only revascularization in the elderly aged group was higher than that in the elderly group.The incidence of MACE events,acute heart failure and pulmonary infection in the elderly aged group was higher than that in the elderly group(12.7%vs 4.6%,42.8%vs 19.5%,41.6%vs 16.7%),but there was no significant difference in the incidence of ventricular aneurysm and malignant arrhythmia between the two groups.Conclusions1.The risk factors of the elderly aged patients are different from those of the middle-aged patients.The proportion of hypertension and diabetes in the elderly aged group was higher than that in the middle-aged group,while the proportion of smoking,hyperlipidemia and overweight/obesity was lower than that in the middle-aged group.Diabetes,LDL-C and smoking are the independent risk factors of the elderly aged AMI patients,and HDL-C is the protective factor of AMI in the elderly aged AMI patients.2.There is aggregation of risk factors in elderly aged patients with AMI.3.Most of the elderly aged AMI patients had atypical clinical symptoms.The proportion of CAG and PCI,and the proportion of using aspirin?ticagrelor?GP2b/3a inhibitors and ?-receptor blockers during hospitalization in the elderly aged patients were lower,and they were usually associated with worse cardiac and renal function.Coronary artery lesions were mainly multi-vessel lesions,and the proportion of MACE,acute heart failure and pulmonary infection was higher during hospitalization.