Comparison of clinical presentation of acute myocardial infarction in patients older than 65 years of age to younger patients: The multicenter chest pain study experience

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Abstract

To assess whether the manifestations of acute ischemic heart disease in the elderly are less typical than in younger patients, the presenting clinical features and their associated relative risks for acute myocardial infarction (AMI) were compared in 2,625 patients ≥ 65 years of age and 5,109 patients < 65 years of age. These patients were evaluated for acute chest pain in the emergency departments of 7 hospitals. The same features were associated with increased relative risks for AMI in younger and elderly patients. The relative risks among older patients, however, were consistently closer to 1.0 for classic features, including male gender, pressure-like quality of pain, substernal location, typical pattern of pain radiation and electrocardiographic evidence of ischemia or AMI. Analyses for the endpoint “acute ischemic heart disease” (i.e., AMI or unstable angina) yielded similar findings. Elderly patients were more likely to be admitted to the hospital (56 vs 35%; p < 0.0001) and to the coronary care unit (37 vs 23%; p < 0.0001) in the absence of either AMI or unstable angina. These data support the hypothesis that diagnosis of acute chest pain is especially difficult in elderly patients.

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    This study was supported in part by grant 83102-2H from the John A. Hartford Foundation, New York, New York.

    1

    Dr. Lee is the recipient of a Public Health Service Clinical Investigator Award (HL01594-01) from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.

    2

    Dr. Rouan is a Teaching and Research Scholar of the American College of Physicians and was supported in part by a grant to the Training Program in Clinical Effectiveness from the W.K. Kellogg Foundation, Battle Creek, Michigan.

    See Appendix.

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