Presentation, Treatment, and Outcomes of the Oldest-Old Patients with Acute Myocardial Infarction: The SILVER-AMI Study

Link to article at PubMed

Am J Med. 2020 Aug 14:S0002-9343(20)30696-3. doi: 10.1016/j.amjmed.2020.07.020. Online ahead of print.


BACKGROUND: Oldest-old patients (≥85 years) constitute half the acute myocardial infarction hospitalizations among older adults and more commonly have atypical presentation, under-treatment and functional impairments. Yet this group has not been well characterized.

OBJECTIVES: We characterized differences in presentation, functional impairments, treatments, health status, and mortality among middle-old (75-84 years) and oldest-old patients with myocardial infarction.

METHODS: We analyzed data from the ComprehenSIVe Evaluation of Risk Factors in Older Patients with AMI (SILVER-AMI) study that enrolled 3041 patients ≥75 years of age from 94 hospitals across the US between 2013-2016. We performed Cox proportional hazards regression to examine the association between the oldest-old (n=831) and middle-old (n=2210) age categories with post-discharge 6-month case fatality rate adjusting for socio-demographic and clinical variables, and mobility impairment.

RESULTS: The oldest-old were less likely to present with chest pain (52.7% vs. 57.7%) as their primary symptom or to receive coronary revascularization (58.1% vs. 71.8) (p<0.01 for both). The oldest-old were more likely to have functional impairments and had higher 6-month mortality compared with the middle-old patients (HR 1.78, 95% CI 1.39-2.28). This association was substantially attenuated after adjusting for mobility impairment (HR 1.29, 95% CI 0.99-1.68).

CONCLUSIONS: There is considerable heterogeneity in presentation, treatment and outcomes among older patients with myocardial infarction. Mobility impairment, a marker for frailty, modifies the association between advanced age and treatments as well as outcomes.

PMID:32805225 | DOI:10.1016/j.amjmed.2020.07.020

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