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Vol. 215. Issue 4.
Pages 195-203 (May 2015)
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Vol. 215. Issue 4.
Pages 195-203 (May 2015)
Original article
DOI: 10.1016/j.rceng.2014.11.001
Myocardial infarction in older than 75 years: An increasing population. CASTUO study
Infarto de miocardio en mayores de 75 años: una población en aumento. Estudio CASTUO
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D. Fernández-Bergésa,b,
Corresponding author
polonibo@gmail.com

Corresponding author.
, F.J. Félix-Redondob,c, L. Consuegra-Sánchezd, L. Lozano-Merab,e, I. Miranda Díazb, M. Durán Guerreroa, F. Benítez de Castroa, J.B. Polanco Garcíaa, J.R. López-Mínguezf
a Sección de Cardiología, Departamento de Medicina Interna, Hospital Don Benito-Villanueva, Don Benito, Badajoz, Spain
b Unidad de Investigación Programa de Investigación en Enfermedades Cardiovasculares PERICLES, Villanueva de la Serena, Badajoz, Spain
c Centro de Salud Villanueva de la Serena Norte, Villanueva de la Serena, Badajoz, Spain
d Servicio de Cardiología, Hospital Universitario de Santa Lucia, Cartagena, Murcia, Spain
e Centro de Salud Mérida Urbano, Mérida, Badajoz, Spain
f Servicio de Hemodinámica, Hospital Universitario Infanta Cristina, Badajoz, Spain
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Figures (1)
Tables (6)
Table 1. Patient characteristics, overall and grouped as younger or older than 75 years.
Table 2. Patient characteristics, by sex and grouped as younger or older than 75 years.
Table 3. Medication and procedures indicated for patients grouped as younger or older than 75 years and in four 30-month periods.
Table 4. Hospital mortality prediction model.
Table 5. Long-term mortality prediction model (median 4.6; P25–75, 2.1–7.3).
Table 6. First-degree interactions between age and medical treatment and angioplasty (dichotomized at 75 years) in the hierarchical model.
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Abstract
Objectives

Elderly patients with acute myocardial infarction constitute a population that is not adequately represented in clinical trials or medical registries. Our objective was to compare the clinical characteristics, treatments administered and mortality among patients younger and older than 75 years.

Materials and methods

Observational retrospective study of patients hospitalized for acute myocardial infarction in the decade 2000–2009. Multivariate models were constructed to determine hospital and late mortality (median, 4.6 years; IQR 25–75: 2.1–7.3).

Results

We included 2177 patients (995 men [79%]), with a mean age of 70.8 years (SD, 12.6). A total of 917 (42.0%) of the patients were 75 years of age or older. When compared with the patients younger than 75 years, the older patients had a greater prevalence of diabetes (38.3% vs. 32.5%; P<.002), chronic obstructive pulmonary disease (15.6% vs. 11.2%; P<.002), stroke (14.3% vs. 7.3%; P<.001), chronic renal failure (11.0% vs. 3.9%; P<.001), atrial fibrillation (15.9% vs. 6.9%; P<.001), heart failure (28.0% vs. 23.4%; P<.008). The older patients were treated with fewer beta-blockers (55.9% vs. 71.2%; P<.001), statins (44.3% vs. 62.3%; P<.001), coronary angiographies (17.9% vs. 48.5%; P<.001) and angioplasties (10.8% vs. 29.1%; P<.001). The patients older than 75 years had lower survival (mortality, 44.5% vs. 18.9%; HR 1.89; 95% CI 1.57–2.29). The use of beta-blockers (HR, 0.74; 95% CI 0.62–0.89), statins (HR 0.73; 95% CI 0.58–0.91) and angioplasty (HR, 0.42; 95% CI 0.30–0.57) was inversely correlated with mortality.

Conclusions

Patients older than 75 years with acute myocardial infarction had lower survival and were treated with fewer beta-blockers, statins and angioplasty, indications that are associated with lower mortality.

Keywords:
Myocardial infarction
Elderly
Mortality
Epidemiology
Resumen
Objetivos

Los ancianos con infarto agudo de miocardio constituyen una población que no está adecuadamente representada en ensayos clínicos ni en registros médicos. Nuestro objetivo fue comparar, entre pacientes menores y mayores de 75 años, las características clínicas, los tratamientos administrados y la mortalidad.

Material y métodos

Estudio observacional y retrospectivo de pacientes ingresados por infarto agudo de miocardio en la década 2000-09. Se construyeron modelos multivariados para estimar mortalidad hospitalaria y tardía (mediana 4,6 años; RI 25-75: 2,1-7,3).

Resultados

Se incluyeron 2.177 pacientes (hombres 995 [79%]) con una edad media de 70,8 años (DE: 12,6). Un total de 917 (42,0%) tenían 75 años o más. Estos enfermos comparados con los menores de 75 años presentaron mayor prevalencia de diabetes (38,3 vs. 32,5%; p<0,002), enfermedad pulmonar obstructiva crónica (15,6 vs. 11,2%; p<0,002), ictus (14,3 vs. 7,3%; p<0,001), insuficiencia renal crónica (11 vs. 3,9%; p<0,001), fibrilación auricular (15,9 vs. 6,9%; p<0,001), insuficiencia cardiaca (28 vs. 23,4%; p<0,008). Recibieron menos betabloqueantes (55,9 vs.71,2%; p<0,001) y estatinas (44,3 vs. 62,3%; p<0,001), se les realizaron menos coronariografías (17,9 vs. 48,5%; p<0,001) y angioplastias (10,8 vs. 29,1; p<0,001). Los mayores de 75 años mostraron una menor supervivencia (mortalidad 44,5 vs. 18,9%), HR 1,89 (IC 95%: 1,57-2,29), asociándose inversamente con la mortalidad tardía: betabloqueantes (HR=0,74; IC 95%: 0,62-0,89), estatinas (HR: 0,73; IC 95%: 0,58-0,91) y angioplastias (HR=0,42; IC 95%: 0,30-0,57).

Conclusiones

Los pacientes mayores de 75 años con infarto agudo de miocardio tuvieron menor supervivencia y recibieron menos betabloqueantes, estatinas y angioplastias, indicaciones que se asocian a una menor mortalidad.

Palabras clave:
Infarto de miocardio
Ancianos
Mortalidad
Epidemiología

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