Prediction on Admission of In-Hospital Mortality in Patients Older Than 70 Years With Acute Myocardial Infarction

¹ From the Coronary Unit—Intensive Care Unit, Hospital Regional Carlos Haya, Malaga, Spain

Study objective: To identify the differential characteristics regarding risk factors, presentation, and clinical status on hospital admission in patients aged 70 years or older with acute myocardial infarction (MI) of less than 24 h of evolution, compared with patients younger than 70 years, and to analyze possible factors that could affect mortality on admission in the group of patients older than 70 years.

Study design: Of 1,289 patients admitted in the coronary care unit with acute MI during the period 1988 to 1991, with a delay from onset of symptoms of less than 24 h, we defined two groups according to age: younger than 70 years (group 1) and 70 years or older (group 2) in order to analyze the possible predictive factors for mortality on hospital admission in patients older than 70 years (n=322). By means of univariate analysis, we studied clinical variables that were present on admission; age; sex; medical history of diabetes, cerebrovascular accident, stable angina, previous MI, cardiac failure, right bundle branch block, and atrial fibrillation; previous treatment with digoxin, calcium antagonists, angiotensin-converting enzyme inhibitors (ACEI), antiaggregants or β-blockers; location and extension of the acute MI, and thrombolysis. The association between mortality, as the dependent variable, and all other variables, as independent variables, was evaluated using a stepwise logistical regression procedure.

Results: In patients older than 70 years of age, the model included the following as independent predictors of mortality: female sex (odds ratio [OR], 2.59); complete right bundle branch block (CRBBB) (OR, 4.88); Q-wave MI (OR, 0.35 for non-Q-wave MI); and Forrester grade 2 to 3 (OR, 6.36) and 4 (OR, 80.14).

Conclusions: In patients with acute MI and older than 70 years at the time of admission to the coronary care unit, together with the variables indicating the degree of hemodynamic involvement and the extension of the acute MI, factors such as female sex and CRBBB stand out as independent predictors of mortality.

Key Words: acute myocardial infarction • age • mortality • risk factors

Submitted on March 23, 1994
Accepted on September 1, 2007

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