Patient-dependent variables affecting treatment and prediction of acute coronary syndrome are age-related. A study performed in Israel.
BACKGROUND
Acute coronary syndrome (ACS) prevails in older patients and is associated with higher morbidity and mortality. Little is known about patient-related variables that may affect course and treatment of ACS in older vs. younger with acute chest pain.


METHODS
Situational, circumstantial, and other patient-related variables were assessed in 1000 unselected consecutive older (> or =70 years) and younger (<70 years) patients admitted with chest pain and possible ACS.


RESULTS
In 182 older vs. 818 younger patients, prevalence of females, those not speaking the local language, living alone, lower education level, non-smokers, diabetes, hypertension, preexisting coronary artery disease, and attempting some form of self-treatment before seeking medical help were significantly greater (P<0.001). Interval from chest pain onset to emergency department arrival was longer (P=0.05), and a higher proportion of the older considered hospitalization mandatory, suspecting ACS (P<0.001). ACS eventually developed in 19.1% of younger and 39% of older patients (P<0.001). On multivariate analysis, most predictive of ACS in the younger group were: preexisting coronary artery disease (OR 5.27; 95% CI 3.44-8.07, P<0.001), current smoking (OR 1.78; 95% CI 1.16-2.75, P=0.002), male sex (OR 1.57; 95% CI 1.0-2.59, P=0.07), and older age (OR 1.25; 95% CI 1.11-1.42, P=0.005). In the older group, these were: not speaking the local language (OR 2.39; 95% CI 1.19-4.79, P=0.005), preexisting coronary artery disease (OR 1.95; 95% CI 1.0-3.87, P=0.026), direct emergency department arrival (OR 1.9; 95% CI 1.0-3.77, P=0.066), and diabetes (OR 1.84; 95% CI 1.0-3.56, P=0.079).


CONCLUSIONS
We defined age-associated differences in patient-related variables that may predict ACS and affect treatment negatively. These variables might improve risk stratification upon hospitalization.
Gorelik
Oleg
O
Department of Internal Medicine F, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Ramat Aviv, Israel.
Almoznino-Sarafian
Dorit
D
Yarovoi
Israel
I
Alon
Irena
I
Shteinshnaider
Miriam
M
Tzur
Irma
I
Modai
David
D
Cohen
Natan
N
D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics / Q000453:epidemiology* / Q000628:therapy*; D011237:Predictive Value of Tests; D012737:Sex Factors; D012959:Socioeconomic Factors; D016896:Treatment Outcome