[Acute coronary syndrome in elderly patients: experience of Aix-en-Provence General Hospital].
BACKGROUND
Cardiovascular causes are the first causes of death in elderly patients. Nevertheless, elderly patients are underrepresented in randomized studies of acute coronary syndromes although treatment of ACS for elderly patients has specificities that need special attention.


RESULTS
To discuss these specificities, we realized a retrospective study involving patients aged more than 75years old and admitted for ACS in the cardiology department of Aix-en-Provence General Hospital in the first six months of 2010 (Group A) and 2012 (Group B) which we compared. Initial presentation was chest pain in only 78.6% of Group A versus 81.6% in Group B (NS), renal insufficiency was found in 41.4% of the patients of Group A versus 50.5% of the patients in Group B (NS), anaemia was found in 34.3% of Group A patients versus 40.2% of Group B (NS), invasive strategy is less systematic with 74.2% of Group A patients having a revascularization versus 73.6% of Group B (NS), Drug Eluting Stents were less frequently used with 14.3% of Group A patients versus 14.7% of Group B (NS), radial access was used for angioplasty in 61.2% of Group A patients versus 80.2% of Group B (P=0.02), unfractioned heparin was used in 74.3% of the cases in Group A versus 68% in Group B (NS).


CONCLUSIONS
Acute coronary syndrome of the elderly patients has numerous specificities, first there are frequent unusual presentation making diagnosis more difficult, second they have frequent co morbidities making them frail patients with higher risk of hemorrhagic complications and lesser tendency to invasive evidence based treatment. In the absence of specific recommendations, their treatment should not differ from younger patients. This work allowed us also to evaluate our professional practices in order to improve them; we note a positive evolution with the significant raise in the use of radial access, invasive strategy though should be more systematic and use of low molecular weight heparin and Fondaparinux should be more frequent.
Service de cardiologie, centre hospitalier d'Aix-en-Provence, avenue des Tamaris, 13616 Aix-en-Provence cedex 1, France. Electronic address: hadi_kha@hotmail.com.
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H
Khachab
Y
Y
Rahal
L
L
Boulain
C
C
Barnay
R
R
Morice
J
J
Taieb
T
T
Benchaa
B
B
Jouve
D054058:Acute Coronary Syndrome / Q000401:mortality* / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D000925:Anticoagulants / Q000627:therapeutic use; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002637:Chest Pain / Q000453:epidemiology / Q000209:etiology; D003328:Coronary Thrombosis / Q000453:epidemiology; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000706:statistics & numerical data*; D004417:Dyspnea / Q000453:epidemiology / Q000209:etiology; D005221:Fatigue / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005602:France / Q000453:epidemiology; D006470:Hemorrhage / Q000453:epidemiology; D006493:Heparin / Q000627:therapeutic use; D006760:Hospitalization; D006769:Hospitals, General; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017534:Radial Artery; D051437:Renal Insufficiency / Q000453:epidemiology; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D006493:Heparin
Acute coronary syndrome; Comorbidities; Comorbidités; Elderly patients; Sujet âgé; Syndrome coronarien aigu