A Study of Acute St Elevation Myocardial Infarction (stemi) in Elderly Patients in a Tertiary Care Institute in South India
Year: 2018
Type: article
Study design: Observational Study
Abstract: BACKGROUNDCoronary Artery Disease (CAD) is the leading cause of morbidity and mortality among elderly.The clinical features of Acute ST Elevation Myocardial Infarction (STEMI) in elderly are different from those in young patients in many aspects.The elderly STEMI patients are often less aggressively treated than younger ones due to advanced age, co-morbidities and delayed admission to the hospital.The epidemiological data regarding STEMI in elderly in India are mainly from urban centres.Hence, we conducted a study on the clinical presentation, risk factors and complications of elderly STEMI (> 60 years) patients admitted in the ICCU of Department of Cardiology, Thanjavur Medical College, Tamilnadu which caters to the needs of largely rural population. MATERIALS AND METHODSOur retrospective descriptive study was conducted on patients > 60 years of age, who were admitted with the features of acute STEMI from 1 st January 2018 to 30 th September 2018.The demographic features, cardiovascular risk factors, clinical presentations, serial ECG changes and 2D-Echo features were analysed and correlated. RESULTSOut of 87 patients studied, 58 (66.67%) were Male and 29 (33.33%) were Female with Male-to-Female ratio of 2:1.However, above 80 years of age, there were more Females (20.69%) than Males (1.72%).Majority of the patients belonged to 60-70 years' age group (66.67%).Type II Diabetes Mellitus (28.74%) and Systemic Hypertension (25.29%) were the common risk factors.Though 50.57% of patients presented with chest pain, atypical symptoms were present in significant number of patients.Majority were in Killip's class II (47.13%) on admission.IWMI occurred slightly more (49.42%)than AWMI (48.28%).RVMI occurred in 37.21% of patients with acute IWMI.LVEF < 40% was more common in AWMI (64.28%) group and in non-thrombolysed (50%) patients.Mitral regurgitation was present in 57 (65.52%) cases, while cardiogenic shock was present in 14.95% of cases.5 patients (5.74%) died during their hospital stay. CONCLUSIONSTEMI in the elderly presented commonly between 60-70 years of age.Female patients with STEMI increased with increasing age (>70 yrs.).Diabetes Mellitus and Systemic Hypertension were the common risk factors.More patients presented with atypical symptoms and in Killip's class II.IWMI was more common than AWMI.37.21% of patients with IWMI had RVMI.LV systolic dysfunction with LVEF < 40% was more common in AWMI and in non-thrombolysed patients.Advanced age, female gender, multiple risk factors, co-morbid conditions, extensive infarction and severe LV systolic dysfunction were the major contributors of in-hospital mortality.
Authors: Gopalakrishnan Senthilkumar, Alagarsamy Srinivasan
Institution: Tamil University
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W2936556586