Acute Coronary Syndrome in Malaysian Octogenarian: Trends in Demographics and In-Hospital Managements

Abstract

Background: Octogenarians have often been neglected in the populational study of disease despite being at the highest point of non-modifiable disease risk burden and the fastest-growing age group for the past decade. This study examined the characteristics and in-hospital management of octogenarian patients with acute coronary syndrome (ACS).Method: This retrospective study utilised the Malaysian National Cardiovascular Disease- ACS (NCVD-ACS) registry. Patients ≥ 80 years old admitted with ACS at 23 participating hospitals from 2008 to 2017 (n=3,080) were identified. Demographics, in-hospital intervention, and evidence-based pharmacotherapies were examined. Binary logistic regression was used.Results: Octogenarians made up 3.8% of patients with ACS in the NCVD-ACS registry (53% men, mean age=83.3, SD±3.4) within the 10-year. The largest ethnic group was Chinese (44%). Hypertension (78%) was the main CV risk factor. Most octogenarians (90.4%) have multiple CV risk factors. Non-ST-elevation myocardial infarction (NSTEMI) predominated (38%, p<0.001). Only 10% of octogenarians with ACS underwent percutaneous coronary intervention (PCI), the majority being STEMI patients (17.5%; p<0.05). More than 80% were prescribed aspirin (91.3%) either alone or combined, dual antiplatelet therapy (DAPT) (83.3%), anticoagulants (89.7%) and statins (89.6%), while less than half were prescribed angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (47.6%) and beta-blocker (43.0%). From 2008 until 2017, there were positive increments in cardiovascular intervention and pharmacotherapies. Men were more likely to receive PCI than women (Odds Ratio (OR): 0.698; 95%CI: 0.490-0.993). Those with NSTEMI (OR=0.402, 95% CI: 0.278-0.583) and unstable angina (UA) (OR=0.229, 95% CI: 0.143-0.366 were less likely to receive PCI but more likely to be given anticoagulants (NSTEMI, OR=1.543, 95% CI: 1.111-2.142; UA, OR=1.610, 95% CI: 1.120-2.314) than STEMI octogenarians. The presence of cardiovascular risk factors and comorbidities influences management. For example, those with congestive heart failure were more likely to be given PCI and evidence-based pharmacotherapies.Conclusion: Despite being the most vulnerable age group, octogenarians were conservatively treated with evidence-based treatment of ACS. As it is expected that the number of octogenarians with ACS will continue to increase thus the country needs to prepare to improve the management of this specific group of patients.