Impact of age on management and outcome of acute coronary syndrome: observations from the Global Registry of Acute Coronary Events (GRACE).
BACKGROUND
Evidence-based cardiac therapies are underutilized in elderly patients. We assessed differences in practice patterns, comorbidities, and in-hospital event rates, by age and type of acute coronary syndrome (ACS).


METHODS
We studied 24165 ACS patients in 102 hospitals in 14 countries stratified by age.


RESULTS
Approximately two-thirds of patients were men, but this proportion decreased with age. In elderly patients (> or = 65 years), history of angina, transient ischemic attack/stroke, myocardial infarction(MI), congestive heart failure, coronary artery bypass graft (CABG) surgery, hypertension or atrial fibrillation were more common, and delay in seeking medical attention and non-ST-segment elevation MI were significantly higher. Aspirin, beta-blockers, thrombolytic therapy, statins and glycoprotein IIb/IIIa inhibitors were prescribed less, while calcium antagonists and angiotensin-converting enzyme inhibitors were prescribed more often to elderly patients. Unfractionated heparin was prescribed more often in young patients, while low-molecular-weight heparins were similarly prescribed across all age groups. Coronary angiography and percutaneous intervention rates significantly decreased with age. The rate of CABG surgery was highest among patients aged 65-74 years (8.1%) and 55-64 years (7.7%), but reduced in the youngest (4.7%) and oldest (2.7%) groups. Major bleeding rates were 2-3% among patients aged < 65 years, and > 6% in those > or = 85 years. Hospital-mortality rates, adjusted for baseline risk differences, increased with age (odds ratio: 15.7 in patients > or = 85 years compared with those < 45 years).


CONCLUSIONS
Many elderly ACS patients do not receive evidence-based therapies, highlighting the need for clinical trials targeted specifically at elderly cohorts, and quality-of-care programs that reinforce the use of such therapies among these individuals.
Avezum
Alvaro
A
Dante Pazzanese Cardiology Institute, Research Division, São Paulo, Brazil. avezum@yahoo.com
Makdisse
Marcia
M
Spencer
Frederick
F
Gore
Joel M
JM
Fox
Keith A A
KA
Montalescot
Gilles
G
Eagle
Kim A
KA
White
Kami
K
Mehta
Rajendra H
RH
Knobel
Elias
E
Collet
Jean-Philippe
JP
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000401:mortality / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D012042:Registries; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*