Does Advanced Age Reduce the Typicality of Clinical Presentation in Patients with Acute Chest Pain Related to Coronary Artery Disease?

Cardiovascular risk factors, clinical manifestations and management of myocardial infarction in elderly and long­living patients depending on geriatric status

Aim. To study cardiovascular risk factors, clinical manifestations and management of myocardial infarction (MI) in elderly and long­living patients depending on geriatric status.

Material and methods. Out of 92 patients with MI (mean age, 81,6±4,2), 3 following groups were formed: "frailty" — 35 (38,0%), "prefrailty" — 16 (17,4%), and "no frailty" — 41 (44,6%). The following questionnaires were used: Age Is Not a Hindrance, Mini Nutritional Assessment (MNA), Barthel Index for Activities of Daily Living, Lawton Instrumental Activities of Daily Living Scale, balance test, Gait Speed Test, Timed Up and Go test, grip test, Mini Mental State Examination (MMSE), Clock Drawing Test, Geriatric Depression Scale.

Results. Frailty probability in patients is higher in the presence of obesity, type 2 diabetes, a decrease in glomerular filtration rate (GFR) <60 ml/min/1,73 m2, a stroke, and heart failure. In the event of clinical manifestations of acute coronary syndrome (ACS), patients without frailty sought medical assistance earlier (in the first 2 hours — 26,8% of patients (χ2=7,8, p=0,005). Most patients with prefrailty and frailty called an ambulance later, but in the first 12 hours — 68,8 and 74,3%, respectively (χ2=15,6, p=0,012). The prevalence of thrombolysis is 23,2%, percutaneous coronary intervention — 30,4% and did not depend on geriatric status. The probability of multivessel disease is higher in patients with or at risk of malnutrition. The main hemodynamic parameters, echocardiography, laboratory parameters in patients with MI did not depend on geriatric status. According to the STOPP/START criteria, frail patients with more often received nonrecommended inhospital medicines.

Conclusion. Frailty in patients with MI was associated with multiple cardiovascular risk factors, later medical assistance, and more frequent non-recommended treatment.