70岁以上老年人急性心肌梗死临床特点

The clinical characteristics of acute myocardial infarction in patients aged 70 years and over

目的探讨年龄因素对急性心肌梗死（ＡＭＩ）疾病过程及预后的影响。方法将１９～９６岁４８８例ＡＭＩ住院患者按年龄分组，从发病特点、诱发因素、临床过程及疾病转归等方面进行对比。结果随年龄增长，≥７０岁组女性患者的比率明显增高；≥７０岁组发病与慢性心肌缺血史、高血压、糖尿病明显有关，起病时多无典型胸痛，仅表现为呼吸困难、胃肠道反应、意识障碍等症状，出现心律失常、心力衰竭、心源性休克等并发症及病死率均明显高于１９～５９岁及６０～６９岁两组。结论年龄因素是决定老年ＡＭＩ患者预后的重要指标之一。

Objective To study whether the clinical course and prognosis of acute myocardial infarction (AMI) were mainly affected by the age of the patients. Methods Patients with AMI were divided into 3 groups: 70 years and over (136 cases), between 60 to 69 years (145 cases) and between 19 to 59 years (207 cases). Several aspects including the onset, predisposing factors, clinical course and prognosis of AMI were compared. Results The proportion of females in the group of 70 years and over was much higher than that in the other two groups and it increased with aging. It is shown that the AMI attack was more apparently related with chronic myocardial ischemia, hypertension and diabetes in the group of 70 years and over than in the other two groups. The majority of patients in the group of 70 years and over did not present with typical chest pain, but complained of dyspnea, gastrointestinal disturbance or showed impairment of mentality. The group of 70 years and over had more complications such as arrhythmias, cardiac failure and cardiogenic shock as well as higher mortality rate than the other two groups. Conclusions The factor of age is an important predictor of the outcome of AMI. The results indicated that in hospital prognosis is markedly worse in the group of 70 years and over. Early diagnosis,control of predisposing factors and timely treatment of complications may decrease the mortality rate of AMI in patients aged 70 years and over.