title: Acute coronary syndrome in octogenarians: association between percutaneous coronary intervention and long-term mortality.
abstract: OBJECTIVE
  Evidence of improved survival after use of percutaneous coronary intervention (PCI) in elderly patients with acute coronary syndrome (ACS) is limited. We assessed the association between PCI and long-term mortality in octogenarians with ACS.
  
  
  RESULTS
  We followed 353 consecutive patients aged ≥80 years hospitalized with ACS during 2006-2007. Among them, 182 were treated with PCI, whereas 171 were not. PCI-treated patients were younger and more often male, and had less stroke and dependency in activities of daily living, but there were no significant differences in occurrence of diabetes mellitus, chronic obstructive pulmonary disease, hypertension, and uncured malignancies between the two groups. The association between PCI and all-cause mortality was assessed in the overall cohort and a 1:1 matched cohort based on propensity score (PS). In overall cohort, 5-year all-cause mortality was 46.2% and 89.5% in the PCI and non-PCI groups, respectively. Cox regression analysis in overall cohort by adjustment for ten baseline variables showed statistically significant association between PCI and reduced long-term mortality (P<0.001, hazard ratio 0.4, 95% confidence interval [CI] 0.2-0.5). In propensity-matched cohort, 5-year all-cause mortality was 54.9% and 83.1% in the PCI and non-PCI groups, respectively. Kaplan-Meier survival curves and log rank test showed significantly improved mean survival rates (P=0.001): 48 months (95% CI 41-54) for PCI-treated patients versus 35 months (95% CI 29-42) for non-PCI-treated patients. Furthermore, by performing Cox regression analysis, PCI was still associated with reduced long-term mortality (P=0.029, hazard ratio 0.5, 95% CI 0.3-0.9) after adjustment for PS and confounders: age, male sex, cognitive deterioration, uncured malignancies, left ventricular ejection fraction ≤45%, estimated glomerular filtration rate ≤35 mL/min, ST-segment elevation myocardial infarction, mitral regurgitation, and medication at discharge with clopidogrel and statins.
  
  
  CONCLUSIONS
  In octogenarians with ACS, PCI was associated with improved survival from all-cause death over 5 years of follow-up.
authors.affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden.
authors.forename: Salim Bary
authors.initials: SB
authors.lastname: Barywani
authors.affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden ; Department of Geriatrical Cardiology, PLA General Hospitals, Beijing, People's Republic of China.
authors.forename: Shijun
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Lindh
authors.affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden.
authors.forename: Josefin
authors.initials: J
authors.lastname: Ekelund
authors.affiliation: Centre for Applied Biostatistics, University of Gothenurg, Gothenburg, Sweden.
authors.forename: Max
authors.initials: M
authors.lastname: Petzold
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Albertsson
authors.affiliation: Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden ; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Lars H
authors.initials: LH
authors.lastname: Lund
authors.affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden.
authors.forename: Michael Lx
authors.initials: ML
authors.lastname: Fu
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality* / Q000628:therapy*; D000369:Aged, 80 and over; D002423:Cause of Death; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D062645:Percutaneous Coronary Intervention; D057216:Propensity Score; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology
keywords: acute coronary syndrome; mortality; octogenarians; percutaneous coronary intervention