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May 27, 1996

Comparison of Elderly and Younger Patients With Out-of-Hospital Chest Pain

Arch Intern Med. 1996;156(10):1089-1093. doi:10.1001/archinte.1996.00040041089007

Background:  Acute myocardial infarction is associated with significantly higher mortality in elderly patients compared with younger patients.

Objectives:  To determine clinical differences in elderly and younger patients with acute myocardial infarction. To assess differences in therapies and outcomes between the age groups.

Methods:  Over a 3.5-year period, 2482 consecutive adult emergency medical services patients with chest pain received prehospital electrocardiograms and were entered in the Milwaukee Prehospital Chest Pain Database in Milwaukee, Wis. Clinical characteristics that included cardiac history, description of chest pain, time of onset to presentation, and prevalence of acute myocardial infarction were obtained for all patients. Patients with acute infarction were further analyzed in reference to type of infarction (Q wave vs non—Q wave), therapeutic interventions, and mortality. Patients were stratified in 3 age groups: younger than 70 years (younger), 70 years or older (elderly), and 80 years or older (very elderly); differences were compared among the age groups.

Results:  Even though more than 50% had a history of documented coronary artery disease, elderly patients with ischemic chest pain delayed more than 6 hours in seeking medical assistance after onset of pain. In elderly patients whose chest pain represented an acute myocardial infarction, hospital mortality was double that of younger patients. Thrombolytic therapy reduced hospital mortality by approximately 50% in both younger and elderly patients, although thrombolytic therapies were used in only 17% of the elderly patients compared with 50% of the younger patients (P<.001). Revascularization procedures were also beneficial in elderly patients as well as in younger patients, although this procedure, as with thrombolytic therapy, was less frequently used in elderly patients (48% vs 32%, P<.001).

Conclusions:  Effective methods for reducing time delays from onset of chest pain to accessing health care for elderly persons deserve investigation. Physicians should be aware of the benefits of thrombolytic and revascularization therapies in elderly patients with acute myocardial infarction.(Arch Intern Med. 1996;156:1089-1093)

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