Significance of atypical symptoms for the diagnosis and management of myocardial infarction in elderly patients admitted to emergency departments

• Published in: Archives of cardiovascular diseases Vol. 106; no. 11; pp. 586 - 592
• Main Authors: Grosmaitre, Pierre, Le Vavasseur, Olivier, Yachouh, Estelle, Courtial, Yves, Jacob, Xavier, Meyran, Sylvie, Lantelme, Pierre
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Masson SAS 01.11.2013
• Subjects: Accidental Falls; Acute coronary syndromes; Age Factors; Aged; Aged, 80 and over; Angina Pectoris - etiology; Cardiovascular; Clinical presentation; Delirium - etiology; Dyspnea - etiology; Elderly patients; Electrocardiography; Emergency department; Emergency Service, Hospital; Female; France; Gastrointestinal Diseases - etiology; Geriatric Assessment; Humans; Internal Medicine; Male; Myocardial Infarction - complications; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Myocardial Reperfusion; Patient Admission; Predictive Value of Tests; Présentation clinique; Retrospective Studies; Risk Factors; Service d’urgence; ST-segment elevation myocardial infarction; Sujet âgé; Syncope - etiology; Syndrome coronarien aigu; Syndrome coronarien aigu avec sus-décalage du segment ST; Time Factors; Time-to-Treatment; Treatment Outcome; France; Syndrome coronarien aigu avec sus-décalage du segment ST; NRMI; Global Registry of Acute Coronary Events; Sujet âgé; ECG; SEGA; National Registry of Myocardial Infarction; Elderly patients; Syndrome coronarien aigu; Service d’urgence; ACS; SD; electrocardiogram; Emergency department; Clinical presentation; Présentation clinique; GRACE; Short Emergency Geriatric Assessment; STEMI; ST-segment elevation myocardial infarction; Acute coronary syndromes; ED; standard deviation
• ISSN: 1875-2136; 1875-2128
• DOI: 10.1016/j.acvd.2013.04.010

Summary Background Few recent studies have examined the characteristics of ST-segment elevation myocardial infarction (STEMI) among elderly patients managed in emergency departments (EDs). Aims To describe the clinical characteristics and management of elderly STEMI patients in EDs. Methods This retrospective, multicentre study involved STEMI patients aged ≥ 75 years admitted to four different EDs in the city of Lyon between 2004 and 2008. Results Among 255 patients, reasons for admission to the ED included chest pain (41.2%), faintness and/or fall (15.7%), dyspnoea (15.7%), digestive symptoms (9.8%), impaired general condition (6.7%) and delirium (5.0%). Compared with those who presented with chest pain, patients admitted for other reasons waited longer before going to the hospital (prehospital delay < 12 hours: 32.0% vs 73.3%; P < 0.001), presented with more severe clinical symptoms (Killip score ≥ III: 28.0% vs 10.5%; P = 0.001), waited longer to be examined in the hospital (waiting time > 1 hour: 36.0% vs 11.4%; P < 0.001), were less likely to receive reperfusion therapy (40.7% vs 77.1%; P < 0.001) and had a higher mortality rate at 1 month (42.7% vs 21.0%; P < 0.001). Such atypical symptoms are more common among patients with cognitive impairment and/or communication difficulties. Conclusion Atypical clinical symptoms of STEMI are common and severe among elderly patients in EDs. Thus, rapid provision of an electrocardiogram to all elderly patients admitted to the ED is essential, even in the absence of cardiovascular symptoms.