title: A decade of changes in clinical characteristics and management of elderly patients with non-ST elevation myocardial infarction admitted in Italian cardiac care units.
abstract: To describe the evolution of clinical characteristics, in-hospital management and early outcome of elderly patients with non-ST elevation myocardial infarction (NSTEMI).
  
  
  
  We analysed data from five consecutive Italian nationwide registries, conducted between 2001 and 2010, including patients with acute coronary syndromes admitted to cardiac care units (CCUs).
  
  
  
  Of 10 983 patients with NSTEMI enrolled in the 5 surveys, 4350 (39.6%) were ≥75 years old (mean age 81±5 years). Some clinical characteristics such as diabetes mellitus, hypertension, renal dysfunction and previous percutaneous coronary intervention increased significantly, whereas a history of stroke, myocardial infarction and heart failure decreased over time. An invasive approach increased from 26.6% in 2001 to 68.4% in 2010 (p<0.0001) and revascularisation rates increased from 9.9% to 51.7% (p<0.0001). Early use and prescription at discharge of β-blockers, statins and dual antiplatelet treatment increased significantly (p<0.0001). Thirty-day observed mortality decreased from 14.6% (95% CI 9.9 to 20.4) to 9.5% (95% CI 7.7 to 11.6). At the multivariate logistic regression analyses adjusted for baseline characteristics, compared with 2001, the risk of death was significantly lower in all the other studies performed at different times with reductions in adjusted mortality between 66% and 45%.
  
  
  
  Over the past decade, substantial changes have occurred in the clinical characteristics and management of elderly patients admitted with NSTEMI in Italian CCUs, with a greater use of revascularisation therapy and recommended medications. These variations have been associated with a reduction in 30-day adjusted mortality rate.
authors.affiliation: Department of Cardiovascular Sciences , European Hospital , Rome , Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: De Luca
authors.affiliation: Department of Cardiology , Ca' Foncello Hospital , Treviso , Italy.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Olivari
authors.affiliation: Cardiovascular and Neurologic Department , San Donato Hospital , Arezzo , Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Bolognese
authors.affiliation: ANMCO Research Center , Florence , Italy.
authors.forename: Donata
authors.initials: D
authors.lastname: Lucci
authors.affiliation: ANMCO Research Center , Florence , Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Gonzini
authors.affiliation: Division of Cardiology , Ospedale San Antonio Abate , Tolmezzo , Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Chiara
authors.affiliation: Department of Cardiology , Maggiore Hospital , Bologna , Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Casella
authors.affiliation: Division of Cardiology, IRCCS Ospedale S. Martino, Genova, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Chiarella
authors.affiliation: Department of Cardiovascular Diseases , S. Giovanni-Addolorata Hospital , Rome , Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Boccanelli
authors.affiliation: Department of Cardiology , Maggiore Hospital , Bologna , Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Pasquale
authors.affiliation: Cardiology Division , Campo di Marte Hospital , Lucca , Italy.
authors.forename: Francesco M
authors.initials: FM
authors.lastname: Bovenzi
authors.affiliation: Division of Cardiology , Ospedale A. Manzoni , Lecco , Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Savonitto