Impact of multimorbidity on risk stratification and prognosis in elderly patients after acute myocardial infarction

Background: Elderly patients with first acute myocardial infarction (AMI) often have serious clinical features and worse prognoses. The purpose of the study was to evaluate the burden of comorbidity in predicting prognosis of elderly patients after AMI.

Methods: A total of 479 elderly patients with AMI divided into three groups: group A (with zero or one comorbidity), group B (with two comorbidities), and group C (with three or more comorbidities). The clinical characteristics, medication, in-hospital complications, and one-year prognosis of these patients were collected and compared across the three groups.

Results: Compared to group A, the age, heart rate, creatinine and uric acid, glucose, left atrial diameter (LAd), relative number of multi-vessel and culprit vessels located in left main (LM) artery and thrombolysis in myocardial infarction (TIMI) grade 0-1 were significantly higher in groups B and C. Compared to group A, the incidences of in-hospital death, paroxysmal atrial flutter/atrial fibrillation, and acute heart failure were significantly higher in groups B and C and that of in-hospital cardiac rupture was remarkably higher in group C. Compared group A, the incidence of one-year major adverse cardiovascular events (MACEs), all-cause death, and attacks of acute heart failure were significantly higher in groups B and C. The incidences of one-year non-fatal ischemic stroke in group C and late revascularization in group B were dramatically higher.

Conclusions: A higher comorbidity burden was associated with more serious clinical presentations, more severe in-hospital complications, and worse one-year prognosis of elderly AMI patients. These findings can help clinicians to identify high-risk elderly AMI patients, determine the prognostic impact of comorbidity, and provide better managements.