Short-Time Survival Rate of Acute Myocardial Infarction in Elderly Patients in Isfahan City, Iran

Document Type : Original Article (s)

Authors

1 Epidemiologist, Isfahan University of Medical Sciences, Isfahan AND PhD Candidate, Department of Biostatistics and Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

2 Professor, Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

3 Associate Professor, Research Institute of Endocrine Sciences, Iran University of Medical Sciences, Tehran, Iran

4 Hypertension Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

5 Associate Professor, Oncopathology Research Centre, Iran University of Medical Sciences, Tehran, Iran

Abstract

Background: Cardiovascular disease is the first cause of mortality and hospital admission in elderly patients. The purpose of this study was to determine the short-term survival rates of acute myocardial infarction among elderly patients by age and sex.Methods: This was cohort-hospital study based on hospital admission in a 10-years period, that contained all elderly patients with acute myocardial infarction (AMI) aged equivalent or more than 65 years in Isfahan and Najaf Abad, Iran. To determine and compare the mean age, we used t-test and for survival rate Kaplan-Meier method and log-rank test were used.Findings: The overall 28-day survival rate for patients aged 65 years and more was 85.5%, against a 86.7% rate for men and 83.5% for women (P < 0.001). Survival rate in the age groups of 65 to 74, 75 to 84 and 85 and more years were 88.7%, 81.3%, 75.6%, respectively, with statistically significant difference (P < 0.001).Conclusion: Short-term survival rates of acute myocardial infarction is lower in elderly women than men; and in two genders, with increasing age, the rate continuously decreases. So, paying attention to women, especially older, due to higher risk of death, could be effective in improving outcomes.

Keywords


  1. Sahyoun NR, Lentzner H, Hoyert DL, Robinson KN. Trends in causes of death among the elderly. Hyattsville, MD: Centers for Disease Control and Prevention, National Center for Health Statistics; 2001.
  2. Nagamine M, Jiang HJ, Merrill CT. Trends in Elderly Hospitalizations, 1997-2004: Statistical Brief #14. 2006.
  3. Shiraki T, Saito D. Clinical features of acute myocardial infarction in elderly patients. Acta Med Okayama 2011; 65(6): 379-85.
  4. Alexander KP, Roe MT, Chen AY, Lytle BL, Pollack CV, Jr., Foody JM, et al. Evolution in cardiovascular care for elderly patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE National Quality Improvement Initiative. J Am Coll Cardiol 2005; 46(8): 1479-87.
  5. White HD, Barbash GI, Califf RM, Simes RJ, Granger CB, Weaver WD, et al. Age and outcome with contemporary thrombolytic therapy. Results from the GUSTO-I trial. Global Utilization of Streptokinase and TPA for Occluded coronary arteries trial. Circulation 1996; 94(8): 1826-33.
  6. Yarzebski J, Goldberg RJ, Gore JM, Alpert JS. Temporal trends and factors associated with extent of delay to hospital arrival in patients with acute myocardial infarction: the Worcester Heart Attack Study. Am Heart J 1994; 128(2): 255-63.
  7. Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J 2008; 29(23): 2909-45.
  8. Timoteo AT, Ramos R, Toste A, Lousinha A, Oliveira JA, Ferreira ML, et al. [Impact of age on treatment and outcomes after acute myocardial infarction, particularly in very elderly patients]. Rev Port Cardiol 2011; 30(12): 897-903.
  9. Lee PY, Alexander KP, Hammill BG, Pasquali SK, Peterson ED. Representation of elderly persons and women in published randomized trials of acute coronary syndromes. JAMA 2001; 286(6): 708-13.
  10. The World Health Organization MONICA Project. MONICA manual, revised edition. Geneva, Switzerland: Cardiovascular Disease Unit, WHO; 1990.
  11. Tunstall-Pedoe H, Kuulasmaa K, Amouyel P, Arveiler D, Rajakangas AM, Pajak A. Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation 1994; 90(1): 583-612.
  12. Mohammadian Hafshejani A, Baradaran Attar Moghaddam HR, Sarrafzadegan N, Bakhsi Hafshejani FA, Hosseini S, Asadi Lari M, et al. Evaluation of short-term survival of patients with acute myocardial infarction and the differences between the sexes in Isfahan and Najaf Abad between (1378-1387). Razi j Med Sci 2012; 19(95): 25-34. [In Persian].
  13. Mohammadian Hafshejani A, Baradaran H, Sarrafzadegan N, Asadi Lari M, Ramezani A, Hosseini S, et al. Predicting factors of short-term survival in patients with acute myocardial infarction in Isfahan using a cox regression model. Iran J Epidemiol 2012; 8(2): 39-47. [In Persian].
  14. Mohammadian Hafshejani A, Baradaran Attar Moghaddam H, Sarrafzadegan N, Asadi Lari M, Roohani M, Allah-Bakhsi F, et al. Secular trend changes in mean age of morbidity and mortality from an acute myocardial infarction during a 10-year period of time in Isfahan and Najaf Abad. J Shahrekord Univ Med Sci 2013; 14(6): 101-14. [In Persian].
  15. Mohammadian Hafshejani A, Sarrafzadegan N, Hosseini S, Baradaran HR, Roohafza H, Sadeghi M, et al. Seasonal pattern in admissions and mortality from acute myocardial infarction in elderly patients in Isfahan, Iran. ARYA Atheroscler 2014; 1(1): 46-54.
  16. Sarrafzadegan N, Oveisgharan S, Toghianifar N, Hosseini S, Rabiei K. Acute myocardial infarction in Isfahan, Iran: Hospitalization and 28th day case-fatality rate. ARYA Atherosclerosis 2009; 5(3): 1-6.
  17. Pop C, Pop L, Dicu D. Epidemiology of acute myocardial infarction in Romanian county hospitals: a population-based study in the Baia Mare district. Rom J Intern Med 2004; 42(3): 607-23.
  18. Yoshida M, Kita Y, Nakamura Y, Nozaki A, Okayama A, Sugihara H, et al. Incidence of acute myocardial infarction in Takashima, Shiga, Japan. Circ J 2005; 69(4): 404-8.
  19. Di CA, Chiarella F, Savonitto S, Lucci D, Bolognese L, De SS, et al. Epidemiology of acute myocardial infarction in the Italian CCU network: the BLITZ study. Eur Heart J 2003; 24(18): 1616-29.
  20. Vrbova L, Crighton EJ, Mamdani M, Moineddin R, Upshur RE. Temporal analysis of acute myocardial infarction in Ontario, Canada. Can J Cardiol 2005; 21(10): 841-5.
  21. Lundblad D, Holmgren L, Jansson JH, Naslund U, Eliasson M. Gender differences in trends of acute myocardial infarction events: the Northern Sweden MONICA study 1. BMC Cardiovasc Disord 2008; 8: 17.
  22. Kubota I, Ito H, Yokoyama K, Yasumura S, Tomoike H. Early mortality after acute myocardial infarction: observational study in Yamagata, 1993-1995. Jpn Circ J 1998; 62(6): 414-8.
  23. MacIntyre K, Stewart S, Capewell S, Chalmers JW, Pell JP, Boyd J, et al. Gender and survival: a population-based study of 201,114 men and women following a first acute myocardial infarction. J Am Coll Cardiol 2001; 38(3): 729-35.
  24. Weaver WD, White HD, Wilcox RG, Aylward PE, Morris D, Guerci A, et al. Comparisons of characteristics and outcomes among women and men with acute myocardial infarction treated with thrombolytic therapy. GUSTO-I investigators. JAMA 1996; 275(10): 777-82.
  25. Gottlieb S, Harpaz D, Shotan A, Boyko V, Leor J, Cohen M, et al. Sex differences in management and outcome after acute myocardial infarction in the 1990s: A prospective observational community-based study. Israeli Thrombolytic Survey Group. Circulation 2000; 102(20): 2484-90.
  26. Sans S, Puigdefabregas A, Paluzie G, Monterde D, Balaguer-Vintro I. Increasing trends of acute myocardial infarction in Spain: the MONICA-Catalonia Study. Eur Heart J 2005; 26(5): 505-15.
  27. Capewell S, Livingston BM, MacIntyre K, Chalmers JW, Boyd J, Finlayson A, et al. Trends in case-fatality in 117 718 patients admitted with acute myocardial infarction in Scotland. Eur Heart J 2000; 21(22): 1833-40.
  28. Marrugat J, Sala J, Masia R, Pavesi M, Sanz G, Valle V, et al. Mortality differences between men and women following first myocardial infarction. RESCATE Investigators. Recursos Empleados en el Sindrome Coronario Agudo y Tiempo de Espera. JAMA 1998; 280(16): 1405-9.
  29. Zubaid M, Rashed WA, Thalib L, Suresh CG. Differences in thrombolytic treatment and in-hospital mortality between women and men after acute myocardial infarction. Jpn Heart J 2001; 42(6): 669-76.
  30. Maynard C, Litwin PE, Martin JS, Weaver WD. Gender differences in the treatment and outcome of acute myocardial infarction. Results from the Myocardial Infarction Triage and Intervention Registry. Arch Intern Med 1992; 152(5): 972-6.
  31. Tunstall-Pedoe H, Morrison C, Woodward M, Fitzpatrick B, Watt G. Sex differences in myocardial infarction and coronary deaths in the Scottish MONICA population of Glasgow 1985 to 1991. Presentation, diagnosis, treatment, and 28-day case fatality of 3991 events in men and 1551 events in women. Circulation 1996; 93(11): 1981-92.
  32. Lee KL, Woodlief LH, Topol EJ, Weaver WD, Betriu A, Col J, et al. Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction. Results from an international trial of 41,021 patients. GUSTO-I Investigators. Circulation 1995; 91(6): 1659-68.
  33. Goldberg RJ, McCormick D, Gurwitz JH, Yarzebski J, Lessard D, Gore JM. Age-related trends in short- and long-term survival after acute myocardial infarction: a 20-year population-based perspective (1975-1995). Am J Cardiol 1998; 82(11): 1311-7.
  34. Ting P, Chua TS, Wong A, Sim LL, Tan VW, Koh TH. Trends in mortality from acute myocardial infarction in the coronary care unit. Ann Acad Med Singapore 2007; 36(12): 974-9.
  35. Kark JD, Fink R, Adler B, Goldberger N, Goldman S. The incidence of coronary heart disease among Palestinians and Israelis in Jerusalem. Int J Epidemiol 2006; 35(2): 448-57.