Outcomes of Elderly Patients with ST-Elevation or Non-ST-Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Abstract

INTRODUCTION: Acute coronary syndromes (ACS) have been classified according to the finding of ST-segment elevation on the presenting electrocardiogram, with different treatment strategies and practice guidelines. However, a comparative description of the clinical characteristics and outcomes of acute coronary syndrome elderly patients undergoing percutaneous coronary intervention during index admission has not been published so far. METHODS: Retrospective cohort study of patients enrolled in the Elderly ACS-2 multicenter randomized trial. Main outcome measures were crude cumulative incidence and cause-specific hazard ratio (cHR) of cardiovascular death, noncardiovascular death, reinfarction, and stroke. RESULTS: Of 1443 ACS patients aged >75 years (median age 80 years, interquartile range 77-84), 41% were classified as ST-elevation myocardial infarction (STEMI), and 59% had non-ST-elevation ACS (NSTEACS) (48% NSTEMI and 11% unstable angina). As compared with those with NSTEACS, STEMI patients had more favorable baseline risk factors, fewer prior cardiovascular events, and less severe coronary disease, but lower ejection fraction (45% vs 50%, P < .001). At a median follow-up of 12 months, 51 (8.6%) STEMI patients had died, vs 39 (4.6%) NSTEACS patients. After adjusting for sex, age, and previous myocardial infarction, the hazard among the STEMI group was significantly higher for cardiovascular death (cHR 1.85; 95% confidence interval [CI], 1.02-3.36), noncardiovascular death (cHR 2.10; 95% CI, 1.01-4.38), and stroke (cHR 4.8; 95% CI, 1.7-13.7). CONCLUSIONS: Despite more favorable baseline characteristics, elderly STEMI patients have worse survival and a higher risk of stroke compared with NSTEACS patients after percutaneous coronary intervention.

Pattern of Cardiovascular Risk Factors and Outcomes of Patients Older Than 80 Years and Presenting with Acute Coronary Syndromes

“…Regarding the presentation, we found that elderly patients more commonly present with NSTE-ACS than STEMI. We also found that the in-hospital mortality rate in this age group was about 3.7% which is more or less similar to that published in other series [15].…”

Residual SYNTAX Score and One-Year Outcome in Elderly Patients With Acute Coronary Syndrome

“…Ejection fraction and eGFR did not show a significant association with outcome, and we decided not to force these otherwise key variables in the final model. Prior studies have shown the relevant prognostic role of prior MI and ACS type, 33 which are clinically correlated with ejection fraction. These stronger predictors could have potentially overcome the prognostic role of ejection fraction in our study population.…”

Advanced age, time to treatment and long-term mortality: single centre data from the FAST-STEMI network

“…Recent trials and registries specific for patients in advanced age presenting with acute coronary syndromes have documented the overall superiority of an early invasive approach over a conservative one [9,10,17].…”

“…The optimization of the networks for transportation and the larger availability of primary-PCI facilities, in particular, have shortened the time to reperfusion and contributed to enlarge the indications to primary PCI even to those higher-risk subsets of patients, as the elderly, that have been associated to an increased rate of complications and poorer outcomes [6][7][8]. Despite the role of a systematically invasive approach, rather than optimal medical therapy, has been largely debated among patients in advanced age or with severe comorbidities, several studies have confirmed the prognostic benefits of early primary PCI even in these settings [9,10].…”