Predictors for development of multiple organ dysfunction syndrome in elderly patients with acute myocardial infarction

Objective Multiple organ dysfunction syndrome (MODS) is one of the leading causes of death in ICU patients. However, there have been few studies on the role of MODS as a cause of death in patients with acute myocardial infarction (AMI), particularly in those at advanced age. Our study aimed to investigate the incidence and to identify the predicting factors of MODS in elderly patients with AMI. Methods We identified consecutive patients with AMI who were discharged from the Chinese PLAGeneral Hospital between January 1993 to June 2006. Medical records of 800 consecutive patients aged 60 years or over were analyzed retrospectively. Multivariate logistic regression was used to determine factors predicting in-hospital development of MODS. Results Twenty-seven (3.4%) patients developed MODS within 30 days after AMI. Compared with patients without MODS, patients with MODS had higher in-hospital mortality rates (55.6% vs 11.6%, P<0.001) and more frequent complications of cardiogenic shock (25.9% vs 6.2%, P<0.001), heart failure (HF) (59.3% vs 18.2%, P<0.001), cardiac arrhythmia (44.4% vs 26.4%, P<0.05) and pneumonia (55.6% vs 16.3%, P<0.001). Multivariate logistic regression analysis showed the major predictors for the occurrence of MODS secondary to AMI were advanced age (≥75 years, odds ratio 2.64, 95% confidence interval CI 1.13 to 6.61), heart rate≥100 bpm on admission (odds ratio 1.74, CI 1.14 to 2.64), in-hospital complication of HF (odds ratio 3.03, CI 1.26 to 7.26) and pneumonia (odds ratio 2.82, CI 1.18 to 6.77). Conclusions MODS is not the uncommon complication in elderly patients with AMI and is associated with poor prognosis. Advanced age, heart failure and pneumonia are predictors of the development of MODS in patients with AMI.