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Srpski arhiv za celokupno lekarstvo 2019 Volume 147, Issue 3-4, Pages: 167-172
https://doi.org/10.2298/SARH171016011D
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Clinical characteristic and management of elderly patients with myocardial infarction

Dejanović Jadranka (Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica + Faculty of Medicine, Novi Sad)
Ivanov Igor (Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica + Faculty of Medicine, Novi Sad)
Popov Tanja ORCID iD icon (Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica + Faculty of Medicine, Novi Sad)
Čanković Milenko ORCID iD icon (Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica + Faculty of Medicine, Novi Sad)
Vulin Aleksandra ORCID iD icon (Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica + Faculty of Medicine, Novi Sad)
Obradović Dušanka ORCID iD icon (Faculty of Medicine, Novi Sad + Institute of Pulmonary Diseases of Vojvodina, Sremska Kamenica)
Ivanović Vladimir (Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica + Faculty of Medicine, Novi Sad)
Stojšić-Milosavljević Anastazija ORCID iD icon (Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica + Faculty of Medicine, Novi Sad)

Introduction/Objective. Population of elderly people is increasing and modern medicine is faced with the problem of large morbidity and mortality from cardiovascular diseases in this age group. Modern treatment strategies have not been sufficiently investigated in the elderly, therefore these people often receive suboptimal treatment. The aim of the study was to evaluate clinical characteristic, cardiac risk factors, management strategies and early outcome in the elderly patient with ST elevated myocardial infarction (STEMI). Methods. This retrospective study included 217 consecutive patients, aged ≥ 70 years (mean age 77.6 ± 4.9 years, 103 men, 114 women) with STEMI admitted to the Institute of Cardiovascular Diseases of Vojvodina. We have analyzed patients’ clinical characteristics, risk factors, left ventricular function and treatment strategies in relation to in-hospital outcome. Results. First clinical symptom was chest pain in 209 (96.3%) of patients. On admission, 35 (16.1%) patients were with severe signs of heart failure (Killip class III–IV). Duration of symptom onset to hospital admission was 14.7 ± 28.6 hours. Out of 217 patients, 168 (77.4%) patients received reperfusion treatment, including primary percutaneous coronary ntervention (PPCI) in 164 (75.6%) patients, and fibrinolytic therapy in 4 (1.8%) patients. Hospital mortality was 26.3% (57 patients). PPCI was univariate predictor of lower in-hospital mortality, whereas multivariate predictors of in-hospital mortality were cardiogenic shock (OR 67.095; 95% CI (6.845–657.646); p < 0.001) and low ejection fraction (OR 0.901; 95% CI (0.853–0.963); p = 0.001). Conclusion. In elederly patients presenting with STEMI, PPCI was asscoiated with lower mortality, whereas cardiogenic shock and lower ejection fraction were independent predictors of worse prognosis after STEMI.

Keywords: ST elevated myocardial infarction, primary percutaneous coronary intervention, fibrinolysis, elderly