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

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.