Clinical profile, management and outcome of very elderly patients with ST-Elevation myocardial infarction

Abstract

ST-Elevation Myocardial Infarction (STEMI) in very elderly patients is associated with worse prognosis. The aim of our study was to assess clinical characteristics, management, and 12-months outcome in very elderly patients hospitalized for STEMI. We retrospectively studied 52 patients 75 years or older hospitalized for STEMI between January 2018 and December 2019 in the cardiology department of the university hospital of Sfax. This population was more likely to be male (69.2% versus(vs) 30.8%) with mean age of 80.28 ± 5.9 years. Hypertension represented the most frequent risk factor (53.8%), followed by diabetes (50%). The average Charlson comorbidity index was 3.48 ± 0,98 (with extremes from 2 to 6). The clinical presentation was atypical in 11.5% of the patients, explaining delayed diagnosis and treatment. Six patients (11.53%) were managed by conservative treatment. Thrombolysis was performed in 5 patients (9.6%). Primary angioplasty was performed in 31 patients (67.4%). Only 51.6% of patients had received complete revascularization. Two patients (5.4%) had in–hospital major cardiovascular events and six patients (11.5%) presented minor bleeding during hospitalization. At 12 months, we observed low rates of adherence to medical treatment concerning essentially Clopidogrel and Statin. At 12-month clinical follow-up, major cardiovascular events were observed in 13 patients (26%). This very elderly population had a high cardiovascular risk profile with a high rate of diabetes. Atypical clinical presentations of STEMI were common in Tunisian very elderly population with poor adherence to treatment at 12-month follow-up concerning especially statins and clopidogrel.