Age, clinical presentation, and outcome of acute coronary syndromes in the Euroheart acute coronary syndrome survey.
OBJECTIVE
Age is one of the most powerful determinants of prognosis in myocardial infarction, but there is comparatively little recent data across the whole spectrum of acute coronary syndromes (ACS). We examined the impact of increasing age on clinical presentation and hospital outcome in a large sample of patients with ACS.


RESULTS
Patients (n = 10 253) from the Euroheart ACS survey in 103 hospitals in 25 countries were investigated. There was a significant inverse association between the age and the likelihood of presenting with ST-elevation. For each decade of life, the odds of presenting with ST-elevation decreased by 0.82 [95% confidence interval (CI) 0.79-0.84]; P < 0.0001. Elderly patients were considerably less often treated by cardiologists, less extensively investigated, and, when presenting with ST-elevation ACS, less likely to be treated with reperfusion. Compared with patients <55 years, the odds ratios of hospital mortality were 1.87 (1.21-2.88) at age 55-64, 3.70 (2.51-5.44) at age 65-74, 6.23 (4.25-9.14) at age 75-84, and 14.5 (9.47-22.1) among patients > or =85 years, with no major differences across different types of admission or discharge diagnoses.


CONCLUSIONS
Elderly ACS patients were less likely to present with ST-elevation but had substantial in-hospital mortality, yet they were markedly less intensively treated and investigated.
Rosengren
Annika
A
Department of Medicine, Sahlgrenska University Hospital/Ostra, Göteborg, Sweden. annika.rosengren@hjl.gu.se
Wallentin
Lars
L
Simoons
Maarten
M
Gitt
Anselm K
AK
Behar
Solomon
S
Battler
Alexander
A
Hasdai
David
D
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality*; D005060:Europe / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality*; D011379:Prognosis; D012307:Risk Factors; D013577:Syndrome