Importance of increasing age on the presentation and outcome of acute coronary syndromes in elderly patients.
OBJECTIVE
The study examined differences in presentation and outcome between elderly (> or =70 years) and very elderly (> or =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 (> or =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 (> or =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.
Halon
David A
DA
Department of Cardiology, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa 34362, Israel. halon@clalit.org.il
Adawi
Salim
S
Dobrecky-Mery
Idit
I
Lewis
Basil S
BS
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000453:epidemiology* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000628:therapy; D017063:Outcome Assessment, Health Care; D016019:Survival Analysis