729 Clinical profile and management of acute myocardial infarction in elderly patients

Abstract

Abstract Aims The management of acute myocardial infarction (AMI) in elderly patients is often challenging for their peculiar clinical profile and the limited clinical evidence available. This represents a major unmet need in cardiovascular medicine, given the progressive ageing of population in western Countries. To investigate the clinical characteristics of elderly patients with AMI at a single tertiary university hospital. Methods and results The EMIR is an ongoing registry including elderly patients (≥75 years) consecutively referred to a single tertiary centre with diagnosis of acute myocardial Infarction with indication for coronary angiography. A total of 760 patients were enrolled to date, 39.6% were female, while mean age was 80 ± 4 years. Most patients had a NSTEMI, while 28% had a STEMI. Time from symptoms’ onset to presentation was 9.4 ± 14.6 for STEMI and 26.5 ± 30.4. Percutaneous coronary intervention (PCI) was performed in 64% of cases. Concomitant PCI of a non-target lesion (NTL) was performed within the same procedure in 8.8% of cases. A staged PCI of NTL was performed in 14% of cases. An elective surgical revascularization was performed after PCI of the IRA in 2.1% of cases. Altogether, a complete revascularization was achieved in 43% of cases before discharge. No evidence of critical coronary stenoses (CCS) was reported in 12.1% of cases, more frequently in females (18%) than in males (8.3%). Patients with no CCS were younger (P = 0.007), more frequently female (P < 0.001), had lower LV-EF (P = 0.002) and a longer time from symptoms’ onset to presentation (P = 0.008). Atrial fibrillation (AF) was present in 17.4% of patients, although only 12.1% of patients had any knowledge of carrying AF. Among patients with AF, 16.7% had no CCS, while the remaining had a formal indication to a combined antiplatelet/anticoagulant treatment. Conclusions Elderly patients with AMI are a specific population, posing peculiar clinical needs and demanding dedicated clinical management protocols.