title: Clinical outcome of older patients with acute coronary syndrome over the last three decades.
abstract: OBJECTIVE
  To Evaluate the clinical outcome of patients with acute coronary syndrome (ACS) in the Coronary Care Unit (CCU) over three decades in Dunedin, New Zealand.
  
  
  METHODS
  Registry study.
  
  
  METHODS
  all consecutive patients (n = 3,013) with ACS admitted to the CCU from 1979 to 1981 (n = 966) and from 1989 to 1991 (n = 1470) were included prospectively. Data on ACS patients managed in the CCU in 2001-2002 (n = 577) were obtained via medical chart review.
  
  
  RESULTS
  There was a rising proportion of older (> or = 75 years of age) patients with ACS (3.8% in 1979-1981, 15.2% in 1989-1991 and 25.6% in 2001-2002, P < 0.0005). However, we observed a progressive reduction of in-hospital mortality for ACS (10.7, 7.3 and 5.0%, P < 0.005) and for ST-elevation myocardial infarction (STEMI) (18.4, 16.1 and 6.6%, P < 0.005). The progressive fall in mortality rate was also observed amongst older patients, both for ACS (27, 19.2 and 11.5%, P = 0.011) and for STEMI (34.8, 30.9 and 15.4%, P < 0.005). Of concern, only 10% of patients presented within 1 h of symptom onset and 50% within 5 h, and this has not changed over three decades. The variables associated with < 5 h from symptom onset to presentation were men [odds ratio (OR) 1.25, 95% confidence interval (CI) 1.10-1.42, P = 0.001], a history of ischaemic heart disease (OR 1.25, 95% CI 1.09-1.43, P = 0.002) and STEMI (OR 1.41, 95% CI 1.18-1.67, P < 0.0001). Advanced age was not a predictor for late presentation.
  
  
  CONCLUSIONS
  Over the past three decades, more old patients were treated in the CCU. However, there was a decline in hospital mortality, particularly for STEMI. Further efforts are required to decrease the time to presentation.
authors.affiliation: Dunedin Public Hospital, Cardiology, Dunedin, Otago, and Dunedin School of Medicine, University of Otego, New Zealand.
authors.forename: Eng Wei
authors.initials: EW
authors.lastname: Tang
authors.forename: Cheuk-Kit
authors.initials: CK
authors.lastname: Wong
authors.forename: Norma J
authors.initials: NJ
authors.lastname: Restieaux
authors.forename: Peter
authors.initials: P
authors.lastname: Herbison
authors.forename: Micheal J A
authors.initials: MJ
authors.lastname: Williams
authors.forename: Patrick
authors.initials: P
authors.lastname: Kay
authors.forename: Gerard T
authors.initials: GT
authors.lastname: Wilkins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000150:complications / Q000401:mortality / Q000628:therapy*; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome