Myocardial infarction in patients aged 75 years and older with occlusive coronary artery disease

Abstract

RELEVANCE. The STEMI-NSTEMI paradigm officially replaced the Q- and non-Q-wave myocardial infarction (MI) paradigm in 2000. This paradigm shift was driven by the reperfusion era, when several large randomized controlled trials demonstrated the efficacy of emergency reperfusion therapy, primarily with thrombolytic therapy. It was therefore necessary to identify patients who would benefit most from such treatment, and it turned out that these were patients with ST-segment elevation on the electrocardiogram (ECG), since such ECG changes in combination with clinical signs and/or symptoms of myocardial ischemia are highly suggestive of coronary artery (CA) occlusion.

However, coronary artery occlusion can be detected not only in patients with acute coronary syndrome (ACS) with ST segment elevation on the ECG, but also in patients with ACS without ST segment elevation on the ECG, as evidenced by the studies of Almendro-Delia M. (2020), Balbi M. M. (2021), Bruno F. (2023), Mohammad A. M. (2024). In this regard, it seems appropriate to analyze the data of patients with MI not only depending on the presence of ST segment elevation on the ECG but also depending on the presence of coronary artery occlusion. This is especially important in patients whose ECG interpretation is difficult: patients with rhythm and conduction disorders, with post-infarction cardiosclerosis, diabetes mellitus, elderly and senile age. It is noteworthy that there are no works devoted to the study of MI with occlusive coronary lesions in patients aged 75 years and older in the available literature.