Cardiovascular disease is a major contributor to morbidity, mortality and quality of life in people aged 60 and over. However, this age group of patients   was not sufficiently included in large studies, in this regard, the management of elderly patients is an urgent problem in modern medicine. The purpose of this review is to analyze literature data on the characteristics comorbid pathology and senile asthenia as a predictor of unfavorable course and outcomes of acute myocardial infarction in patients 60 years of age and older. To analyze the literature, we searched for information on this issue in PubMed/MEDLINE, PMC, Web of Science, Scopus, The Сocrane Library. Recent research data show that there are plenty of risk factors for worsening the course of AMI in patients aged 60 and over. The most important of them are considered to be high comorbidity, multivessel lesion  of  several  pools, the    presence of  senile asthenia. All  together  lead   to difficulties in diagnosing myocardial infarction, to forced polypharmacy and in some cases refraining from early invasive strategy, which worsens the course of the disease, increases the duration of hospital treatment, leads to frequent complications, therepy affects the prognosis of the disease and leads to the development of early disability in patients 60 years of age and older.In the vast majority of elderly patients, the development of acute myocardial infarction occurs against the background of a high prevalence of comorbid pathology, which in turn accelerates the development of senile asthenia and its progression.

acute myocardial infarction, advanced age, senile asthenia, comorbidity, unfavorable prognosis

Shabunova A. A. et al. Mortality of the able-bodied population of Russia and Belarus as a threat to the demographic development of territories [in Russian]. Ekonomicheskiye i sotsial'nyye peremeny: fakty, tendentsii, prognoz (Economic and social changes: facts, trends, forecast). 2012; 2(20):83-97.

Health of the population of the Republic of Kazakhstan and the activities of the healthcare organization in 2019. Statistical collection of the Ministry of Health of the Republic of Kazakhstan, Nur-Sultan 2020; p 16,196.

Chen HY, Gore JM, Lapane KL, et al. A 35-year Perspective (1975-2009) into the Longterm Prognosis and Hospital Management of Patients Discharged from the Hospital after a First Acute Myocardial Infarction. American Journal of Cardiology. 2015; 116(1):24-29. DOI:http://dx.doi.org/10.1016/j.amjcard.2015.03.035

Wan He, Daniel Goodkind, and Paul Kowal, U.S. Census Bureau. International Population Reports, P95/16-1, An Aging World: 2015.

U.S. Government Publishing Office, Washington, DC. 2016; 165. DOI:10.13140/RG.2.1.1088.93625.Nikolich-Žugich J, Goldman DP, Cohen PR, et al. Preparing for an Aging World: Engaging Biogerontologists, Geriatricians and the Society. J Gerontol A Biol Sci Med Sci. 2016; 71(4):435-44. doi: 10.1093/gerona/glv164.

Vladimir Arkhangelsky, Mikhail Denisenko, Valery Elizarov, Baurzhan Zhusupov, Gaziza Moldakulov. Report “Population Situation Analysis of the Republic of Kazakhstan”. UNFPA Kazakhstan 2019; 68-72. https://kazakhstan.unfpa.org.

Bubnova M.G., Barbarash O.L., Doletsky A.A., Krasnitsky V.B., Lebedev E.V.,et al. Acute ST elevation myocardial infarction: After care and secondary prevention. National Russian guidelines [in Russian]. Russian Journal of Cardiology. 2015; (1):6-52. https://doi. org/10.15829/1560-4071-2015-1-6-52

McManus DD, Nguyen HL, Saczynski JS, et al. Multiple cardiovascular comorbidities and acute myocardial infarction: temporal trends (1990-2007) and impact on death rates at 30 days and 1 year. Clin Epidemiol. 2012; 4: 115–23. DOI: 10.2147/CLEP. S30883.

Lopes R.D., Gharacholou S.M., Holmes D.N. et al. Cumulative incidence of death and rehospitalization among the elderly in the first year after NSTEMI. Am J Med, 2015; 128(6):582–90. DOI: 10.1016/j.amjmed.2014.12.03.

Barnett K, Mercer SW, Norbury M, et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012; 380(9836):37-43. doi:10.1016/S0140-6736(12)60240-2.

Guiding principles for the care of older adults with multimorbidity: an approach for clinicians: American geriatrics society expert panel on the care of older adults with multimorbidity. J Am Geriatr Soc. 2012; 60(10):E1-E25. doi:10.1111/j.1532- 5415.2012.04188.x.

Fortin, M., Hudon, C., Haggerty, J. et al. Prevalence estimates of multimorbidity: a comparative study of two sources. BMC Health Serv Res. 2010; 10, 111. https://doi.org/10.1186/1472-6963-10-111.

Rocca W.A., Boyd C.M., Grossardt B.R., et al. Prevalence of multimorbidity in a geographically defined American population: patterns by age, sex, and race/ethnicity. Mayo Clin Proc. 2014; 89(10):1336-49. doi: 10.1016/j.mayocp.2014.07.010.

Oganov R.G., Simanenkov V.I., Bakulin I.G., Bakulina N.V., Barbarash O.L., Boytsov S.A., Boldueva S.A., Garganeeva N.P., Doshchitsin V L., Karateev A.E., Kotovskaya Yu.V., Lila A.M., Lukyanov M.M., Morozova T.E., Pereverzev A.P., Petrova M.M., Pozdnyakov Yu.M., Syrov A.V., Tarasov A.V., Tkacheva O.N., Shalnova S.A. Comorbid pathology in clinical practice. Diagnostic and treatment algorithms [in Russian]. Cardiovascular therapy and prevention. 2019; 18(1):5-66. https://doi.org/10.15829/1728-8800-2019-1-5-66

Boytsov S., Yakushin S., Martsevich S., Lukyanov M., Nikulina N., Zagrebelny A., Vorobiev A., Pereverzeva K., Pravkina E., Deev A., Andrenko E., Ershova A., Meshkov A ., Myasnikov R., Serdyuk S., Kharlap M. Outpatient-polyclinic register of cardiovascular diseases in the Ryazan region (REKVAZA): main tasks, experience of creation and first results [in Russian]. RFK. 2013; https://doi. org/10.20996/1819-6446-2013-9-1-4-14

V.T. Ivashkin, A.A. Sheptulin, I. V. Mayev et al. Clinical guidelines of the Russian Gastroenterological Association for the diagnosis and treatment of peptic ulcer [in Russian]. Ros journal of gastroenterology, hepatology, coloproctology. 2016; 26(6).

Volevach L.V., Nafikova A.Sh., Khismatullina G.Ya. and other Indicators of the quality of life in persons with gastric ulcer of the duodenum [in Russian]. Medical Bulletin of Bashkortostan. 2016; 6:11-15.

18. Dodel R. Multimorbidity: concept, epidemiology and treatment. Nervenarzt. 2014; 85(4):401-08. doi:10.1007/s00115-013-3937-y

19. Hall M, Dondo TB, Yan AT, et al. Multimorbidity and survival for patients with acute myocardial infarction in England and Wales: Latent class analysis of a nationwide population-based cohort. PLOS Medicine. 2018; 15(3):e1002501. doi:10.1371/journal. pmed.100250120.Suaya J.A., Stason W.B., Ades P.A. et al. Cardiac rehabilitation and survival in older coronary patients. J Am Coll Cardiol. 2009; 54(1):25–33. DOI: 10.1016/j.jacc.2009.01.078