Clinical research: coronary artery disease
Importance of increasing age on the presentation and outcome of acute coronary syndromes in elderly patients

https://doi.org/10.1016/j.jacc.2003.08.044Get rights and content
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Abstract

Objectives

The study examined differences in presentation and outcome between elderly (≥70 years) and very elderly (≥80 years) patients hospitalized for acute coronary syndromes (ACS).

Background

The elderly constitute an increasingly important sector of patients with ACS but have been underrepresented in many therapeutic trials.

Methods

We compiled a registry of 449 consecutive patients, 251 elderly (70 to 79 years) (septuagenarians, group 1) and 198 very elderly (≥80 years) (group 2), to examine outcomes in relation to baseline characteristics and treatment. We recorded survival over a period of 24 ± 4 months and rehospitalization and symptomatic status at 16 ± 4 months.

Results

At index hospitalization, the older cohort (group 2) more often had acute myocardial infarction (35% vs. 9.7%, p < 0.0001), heart failure (33.3% vs. 19.4%, p < 0.001), and renal dysfunction (21.6% vs. 12.3%, p = 0.01). They were less likely to undergo coronary angiography (29.3% vs. 43.8%, p = 0.002), but those selected for angiography more often underwent revascularization so that revascularization rates were similar (22.7% group 2 vs. 24.3% group 1, p = NS). Two-year survival rate was poorer in group 2 (67.4 ± 3.5% vs. 83.5 ± 2.5% in group 1, p < 0.0001). Repeat rehospitalization was similar (53.0% vs. 48.2%, respectively, p = 0.31), but improvement in well-being of survivors was greater (60.0% vs. 46.3%, p = 0.01).

Conclusions

The study demonstrated important differences between elderly (70 to 79 years) and very elderly (≥80 years) patients hospitalized with ACS. The older cohort was sicker on admission and had poorer outcome, but a subgroup selected for angiography and possible intervention had two-year outcomes similar to the younger cohort.

Abbreviations

ACS
acute coronary syndromes
AMI
acute myocardial infarction
CAD
coronary artery disease
CPK
creatine phosphokinase
HF
heart failure
HR
hazard ratio
NYHA
New York Heart Association
PCI
percutaneous coronary intervention

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Supported by the Atkins Medical Research Fund for Gerontology.