title: Outcomes of invasive treatment in very elderly Polish patients with non-ST-segment-elevation myocardial infarction from 2003-2009 (from the PL-ACS registry).
abstract: BACKGROUND
  Elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) are rarely included in randomized trials due to concomitant diseases. As a result, invasive treatment and aggressive pharmacotherapy are used less frequently in this group. The aim of the study was to analyze the impact of invasive treatment used for elderly patients (≥ 80 years) with NSTEMI from 2003-2009 and its impact on 24-month outcomes.
  
  
  METHODS
  We performed analysis of 13,707 elderly patients, out of 78,422 total NSTEMI patients, enrolled in the prospective, nationwide, Polish Registry of Acute Coronary Syndromes (PL-ACS) from 2003 to 2009.
  
  
  RESULTS
  The percentage of elderly NSTEMI population was 17.5%. Invasive treatment received 24% of them. In-hospital complications (stroke, reinfarction and death) were significantly less frequent in the invasive group, with the exception of major bleeding, which occurred almost three times more frequently (2.9% vs. 1.1%, p < 0.0001) in the invasive group. The 24-month mortality was lower (29.4% vs. 50.4%, p < 0.0001) in the invasive group and remained so after matching patients by the propensity score method (31.1% vs. 40.9%, p < 0.0001). From 2003 to 2009 the use of thienopyridines, beta-blockers and statins rose significantly. The frequency of invasive strategy increased significantly, from 10% in to over 50% in 2009. The frequency of major bleeding increased twofold, however a significant reduction in the 24-month mortality was observed over the years.
  
  
  CONCLUSIONS
  Elderly patients with NSTEMI benefit significantly from invasive strategies and modern pharmacotherapy recommended by treatment guidelines. Nevertheless, this approach is associated with an increased incidence of major bleeding.
authors.forename: Marek
authors.initials: M
authors.lastname: Gierlotka
authors.forename: Mariusz
authors.initials: M
authors.lastname: Gąsior
authors.forename: Mateusz
authors.initials: M
authors.lastname: Tajstra
authors.forename: Michał
authors.initials: M
authors.lastname: Hawranek
authors.forename: Tadeusz
authors.initials: T
authors.lastname: Osadnik
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Wilczek
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Kalarus
authors.forename: Andrzej
authors.initials: A
authors.lastname: Lekston
authors.forename: Marian
authors.initials: M
authors.lastname: Zembala
authors.forename: Lech
authors.initials: L
authors.lastname: Poloński
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004562:Electrocardiography; D005260:Female; D006470:Hemorrhage / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011044:Poland / Q000453:epidemiology; D012008:Recurrence; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D020521:Stroke / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D010975:Platelet Aggregation Inhibitors