Functional decline in elderly patients presenting with acute coronary syndromes: impact on midterm outcome.
BACKGROUND
Elderly patients with an acute coronary syndrome (ACS) are less likely to be enrolled into randomized, controlled trials or receive guideline-recommended therapies, because of a higher burden of comorbidity, including functional decline.


OBJECTIVE
To assess the prognostic value of functional decline in a prospective, observational cohort of elderly ACS patients.


METHODS
ACS patients aged > or = 70 years were enrolled. The ACS definition included ST- and non-ST-segment elevation myocardial infarction, and unstable angina pectoris. Clinical admission and laboratory data and echocardiographic variables were recorded. Functional decline was defined as needing assisted care in daily life. The study endpoint was all-cause mortality.


RESULTS
Overall, 151 patients were enrolled (mean age 78 + or - 5 years; 52% men). Twenty-eight (19%) patients had functional decline. No significant difference in therapeutic management was observed between patients with functional decline and those living independently. Twenty-seven (18%) patients died during follow-up (median 447 days). Functional decline correlated with poor outcome (p = 0.008; hazard ratio [HR] 2.87 [1.31-6.25]). Other prognostic markers were diabetes, Killip class > or = II, elevated E/Ea ratio, C-reactive protein, B-type natriuretic peptide, haemoglobin, glycaemia and no coronary angiography. By multivariable analysis, C-reactive protein >13 mg/L correlated with poor outcome (p = 0.007; HR 4.77 [1.52-14.96]). There was a trend towards correlation between functional decline and poor outcome (p = 0.051; HR = 2.77 [0.99-7.72]).


CONCLUSIONS
Functional decline seems to portend poor prognosis in elderly ACS patients. Larger, community-based studies are needed to confirm these findings in a multivariable model.
Intensive Cardiology Care Unit, centre hospitalier régional et universitaire de Lille, boulevard Pr.-J.-Leclercq, 59000 Lille, France.
Clémence
C
Huerre
Aurélie
A
Guiot
Sylvestre
S
Maréchaux
Jean-Luc
JL
Auffray
Jean-Jacques
JJ
Bauchart
David
D
Montaigne
Frédéric
F
Mouquet
Martine
M
Lesenne
François
F
Puisieux
Patrick
P
Goldstein
Philippe
P
Asseman
Pierre-Vladimir
PV
Ennezat
D000203:Activities of Daily Living; D054058:Acute Coronary Syndrome / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D016009:Chi-Square Distribution; D015897:Comorbidity; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005602:France / Q000453:epidemiology; D015577:Geriatric Assessment; D006299:Health Services for the Aged; D006801:Humans; D057187:Independent Living; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome