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EFFECTIVE VARIATIONS ON ACUTE MYOCARDIAL INFARCTION IN THE ELDERLY IN A CITY IN WEST OF TURKEY

Aim: Although Turkey has one of the youngest populations when compared
with those of European and Middle Eastern countries, the proportion of
our elderly population has increased year-by-year and as has myocardial
illnesses in parallel. The aim was to investigate the effects of the
monthly, outdoor temperature and weekday variables on acute Myocardial
Infarction (aMI) in the elderly, attending Emergency Departments (EDs).
Methods: The records of patients aged 60 and over who had presented
with aMI to three major EDs of a city in north-west Turkey between
January 1998 and December 2000 were enrolled in the study. Patient
records on the protocol register were reviewed retrospectively for date
and month of presenting, age, gender, and outcome. Daily temperature
records were taken from the Regional Weather and Meteorology Center.
Student's t test, Pearson Chi-square, ANOVA, and Logistic regression
analyses were used for statistical analysis. Results: 79,123 elder
patients had presented to the EDs during the study period. aMI was
diagnosed in 1.56% (n=1,232) patients. The frequency of aMI in males
was higher than that in females (p<0.001). aMI diagnosis in males
was higher than that of females in April and November (p=0.027). There
was a sudden 8.1 oC increase trend of the mean temperature in April and
a 5.4°C decrease in the mean temperature in November.
Statistically significant independent predictors of fatal aMI were male
gender (odds ratio [OR] 2.13, p=0.04), presentation to EDs in the
September-October period(OR 3.43, p=0.01), and mean daily temperatures
of between +1°C and 15°C (OR 3.21, p=0.008) and -22 and
0°C (OR 5.21, p=0.02). Conclusion: aMI and death from aMI were
more frequent in the male gender (elder patients). The frequency of
fatal aMI increased as the temperature decreased, especially when it
fell below 15°C. In addition to seasonal variability, a sudden
increase or decrease in temperatures can be an important risk factor
for aMI in the elderly. Independent predictors found in our study
should be evaluated through further study.