Ground: Cardiovascular diseases are the leading cause of death in elders. As short-term survival from acute myocardial infarction (AMI) improves, more attention is being shifted towards understanding and improving long-term outcomes.
Aim: to evaluate age-associated variations in the long-term prognostic factors following AMI in "real world" patients, focusing on improving risk stratification of eldrly patients.
Methods: A retrospective analysis of 2,763 patients admitted for AMI in 2002-2004 and discharged alive (mean age 66.6±13.3 years; 67.8% males). Two age-groups were created: young (≤65 years; n=1,230) and elders (>65 years; n=1,533). Following data were obtained from the hospital's computerized systems: demographic, cardiovascular risk factors and co-morbidities, AMI clinical characteristics and interventions, and test results. The primary outcome was up-to 10-years post-discharge all-cause mortality.
Results: Higher rate of women, NSTEMI and most co-morbidities were found in elders compared with young; while the rates of invasive treatment were lower.
During the follow-up period mortality rate was higher among the elders versus the young group (69.7% vs. 18.6%).
Some of the parameters includes in the multivariate model had stronger association with the outcome in young (renal diseases, previous myocardial infarction, CABG treatment, hyponatremia, anemia and malignant neoplasm); while others were stronger predictors in elders (older age, significant three vessels or left main coronary artery disease, left atrial dilatation and neurological disorders).
The c-statistics of the multivariate models were 0.75 and 0.74 in young and elders respectively, and 0.86 for the interactive model.
Conclusions. Long-term mortality following AMI in young as well in elderly group can be predicted from simple, easily accessible clinical information. The associations of most predictors and mortality were stronger in younger patients. These predictors can be used for optimizing patient care aiming at mortality reduction.
