[Acute coronary syndrome in nonagenarians: clinical evolution and validation of the main risk scores].
BACKGROUND
Several risk scores regarding the probability of death/complications in the acute setting and during the follow-up of patients admitted with acute coronary syndromes (ACS) have been published, such as the GRACE, TIMI and ZWOLLE risk score. Our objective was to assess the prognosis of nonagenarians admitted to a coronary care unit with an ACS, as well as the usefulness of each of these scores.


METHODS
A retrospective analysis was performed on nonagenarians with an ACS admitted between 2003 and 2011. Vital status was determined at 14, 30 days, and 6 months after the ACS, and later during the follow-up. The risk scores were evaluated by area under the curve ROC (AUC).


RESULTS
A total of 45 patients with an ACS, 26 (57.8%) with ST-segment elevation and 19 (42.2%) with non-ST elevation. The GRACE- AUC for in-hospital mortality was excellent, 0.91, (95% CI: 0.82-1; P<.001), and for the combined event (in-hospital mortality and re-infarction) was 0.83 (95% CI: 0.66-1.0; P<.01). However, the GRACE-AUC at 6 months for mortality was 0.34 (95% CI: 0.09-0.58; P=.45), and for the combined event it was 0.51 (95% CI: 0.26-0.77; P=.95). The TIMI-AUC and ZWOLLE-AUC did not reach statistical significance.


CONCLUSIONS
It is useful calculate the GRACE risk score in order to estimate risk and survival in the acute phase of ACS in nonagenarians. This can help appropriate in making invasive or conservative treatment decisions.
Instituto Cardiovascular, Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Madrid, España.
Sandra
S
Gómez-Talavera
Instituto Cardiovascular, Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Madrid, España. Electronic address: ibnsky@yahoo.es.
Iván
I
Núñez-Gil
Instituto Cardiovascular, Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Madrid, España.
David
D
Vivas
Servicio de Cardiología, Hospital de la Cruz Roja San José y Santa Adela, Madrid, España.
Borja
B
Ruiz-Mateos
Instituto Cardiovascular, Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Madrid, España.
Ana
A
Viana-Tejedor
Instituto Cardiovascular, Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Madrid, España.
Agustín
A
Martín-García
Instituto Cardiovascular, Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Madrid, España.
Javier
J
Higueras-Nafría
Instituto Cardiovascular, Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Madrid, España.
Carlos
C
Macaya
Instituto Cardiovascular, Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Madrid, España.
Antonio
A
Fernández-Ortiz
D054058:Acute Coronary Syndrome / Q000150:complications* / Q000401:mortality*; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment
Acute coronary syndrome; Escala de riesgo GRACE; Estratificación de riesgo; GRACE risk score; Nonagenarians; Nonagenarios; Risk stratification; Síndrome coronario agudo