Do elderly females have a higher risk of acute myocardial infarction? A retrospective analysis of 329 cases at an emergency department

OBJECTIVE: Acute myocardial infarction (AMI) is a medical emergency; a missed or delayed diagnosis of this disease may contribute to a poor outcome and even death. Several studies have found elderly patients with AMI have atypical presentations for diagnosis, therefore we undertook this study to determine the risks among the elderly population, especially in female patients. MATERIALS AND METHODS: In this one-year retrospective study, we reviewed the cases of AMI patients who had visited the emergency department at Mackay Memorial Hospital, Taiwan, and who had either been discharged or had died following a diagnosis of AMI (ICD code 410). We compared the differences between the clinical presentations of these two groups as well as the risk factors, medical management, and outcomes. RESULTS: In our study, only 329 patients (164 elderly; 165 adults) met the defined criteria. The most common symptom of AMI was chest pain, and this was more common in adult patients than in elderly patients (81.8% vs. 60.4%, p < 0.001). In comparison with patients in the adult group, the patients in the elderly group had a significantly higher proportion of females (46.3% vs. 12.7%), non-ST-elevation myocardial infarction (NSTEMI) (71.3% vs. 46.7%), presenting with no chest pain (39.6% vs. 18.2%), shortness of breath (17.7% vs. 8.8%), nausea/vomiting/dizziness (7.9% vs. 2.4%), abdominal pain (4.3% vs. 0.6%), diabetes mellitus (45.1% vs. 26.1%), cerebrovascular disease (22.6% vs. 6.1%), longer hospital stays (18.2 ± 31.0 days vs. 9.8 ± 8.2 days), and increased in-hospital mortality rates (15.9% vs. 6.7%). CONCLUSION: Compared with the adult AMI group, the elderly AMI group had a higher proportion of females, electrocardiography with NSTEMI and no chest-pain complaints, and a larger proportion of elderly patients with diabetes, ischemic heart disease, heart attacks at home and cardiac shock, which had longer hospital stays, and higher mortality rates.