title: Temporal trends in the treatment and outcomes of elderly patients with acute coronary syndrome.
abstract: To determine whether treatment and outcomes of older acute coronary syndrome (ACS) patients changed over time.
  
  
  
  We analysed the use of guideline-recommended therapies and in-hospital outcomes of 13 662 ACS patients ≥70 years enrolled in the prospective Acute Myocardial Infarction in Switzerland (AMIS) cohort between 2001 and 2012 according to 4-year periods (2001-2004, 2005-2008, and 2009-2012). Between first and last 4-year period, percutaneous coronary intervention (PCI) use increased from 43.8 to 69.6% of older ACS patients ( ITALIC! P < 0.001). Use of guideline-recommended drugs as well increased. At the same time, in-hospital mortality of the overall population decreased from 11.6% in the first to 10.0% in the last 4-year period ( ITALIC! P = 0.020), and in-hospital major adverse cardiac and cerebrovascular events from 14.4 to 11.3% ( ITALIC! P < 0.001). Percutaneous coronary intervention was used in increasingly older and co-morbid patients over time (mean age of patients treated with PCI 76.2 years in 2001-2004 and 78.1 years in 2009-2012, ITALIC! P < 0.001; Charlson score ≥2 was found for 27.6% of patients treated with PCI in 2001-2004 and for 32.1% in 2009-2012, ITALIC! P = 0.003). Percutaneous coronary intervention use was associated with similar odds ratios (ORs) of in-hospital mortality over time (adjusted OR 0.29, 95% confidence interval, CI, 0.22-0.40, in 2001-2004; and, adjusted OR 0.26, 95% CI 0.20-0.35, in 2009-2012).
  
  
  
  Use of guideline-recommended therapies for ACS increased and in-hospital outcomes improved over the observed 12-year period. Though PCI was used in increasingly older and co-morbid patients, PCI use was associated with similar ORs of in-hospital mortality over time. This study suggests that increasing use of guideline-recommended therapies was appropriate.
  
  
  
  ClinicalTrials.gov Identifier: NCT01305785.
authors.affiliation: Division of Geriatrics, Department of General Internal Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Andreas W
authors.initials: AW
authors.lastname: Schoenenberger
authors.affiliation: AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001 Zurich, Switzerland.
authors.forename: Dragana
authors.initials: D
authors.lastname: Radovanovic
authors.affiliation: Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.affiliation: Service de Cardiologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Iglesias
authors.affiliation: Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pedrazzini
authors.affiliation: Division of Geriatrics, Department of General Internal Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Andreas E
authors.initials: AE
authors.lastname: Stuck
authors.affiliation: AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001 Zurich, Switzerland paul.erne@erne-net.ch.
authors.forename: Paul
authors.initials: P
authors.lastname: Erne
mesh_terms: D054058:Acute Coronary Syndrome; D000368:Aged; D006801:Humans; D009203:Myocardial Infarction; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D013557:Switzerland; D016896:Treatment Outcome
keywords: Aged 80 and over; Cohort studies; Coronary angiography; Elderly; Myocardial ischaemia