Advancing age and heart failure:the Influencing factors of prognosis in patients with acute myocardial infarction

摘要

The purpose of this study is to determine whether advancing age andheart failure are independent predictors of increased mortality afrer acutemyocardial infarction(AMI)We reviewed the clinical data of 1068 in-patients(344 senile/724 nonsenile)with AMI.The results showed atypicalpresentations of infarction-related symptoms in the elderly are common,with consequent delay in the diagnosis and treatment The elderly patientshad a high proportion of systemic hypertension(43.9%),non Q wave AM/(36%)and heart failure(35.5%),On the contrast,the proportion of that innonsenile patients were 33%,8Vo and 16.4% respectively.In elderlypatients,several complications:of AMI are more common,asinterventricular septum perforation(2%),cardiogenic shock(19.8%),arthythmia(61.9%).Heart failure was more frequent in patients with leftventricular ejection fraction(LVEF)≤35%,previous heart failure ormyocardial infarction,and anterior location infarction.Those with severecongestive heart failure had a mortality of 33.2% compared with 24.5% forthose with moderate heart failure and 13.51% for those with no heart failurein the first eight weeks.The following factors were associated with anincreased risk of death:older age,longer delay before admission to hospital,no prescription of beta-blaekers and a previous history of infarctionOur data suggested that the prognosis after AMI was directly related toadvaneeing age and the severity of congestive heart failure.Thedevelopment of congestive heart failure was an independent predictor ofdeath.The increasing incidence and mortality were closely related toimpaired myocardial reserve.The present benefits,as pointed out by therecent progress in AMI therapy,must be employed in the treatment of olderinfarcted patients More aggressive management in elderly patients shouldoe evaluated for its potential to reduce mortality.