title: Acute coronary syndrome in the elderly: the Malaysian National Cardiovascular Disease Database-Acute Coronary Syndrome registry.
abstract: BACKGROUND
  The elderly are often underrepresented in clinical trials for acute coronary syndrome (ACS), and cardiologists commonly face management dilemmas in the choice of treatment for this group of patients, particularly concerning the use of invasive revascularisation. This study analysed the characteristics of hospitalised elderly patients with ACS, and compared the outcomes of treatments.
  
  
  METHODS
  From 29 December 2005 to 26 April 2010, 13,545 patients were admitted for ACS in 16 hospitals across Malaysia. These patients were divided into two groups - elderly (≥ 65 years) and non-elderly (< 65 years). The clinical characteristics, treatment received (invasive or non-invasive) and outcomes (in-hospital and 30-day all-cause mortality) of the two groups were compared. The elderly patients were then grouped according to the type of treatment received, and the outcomes of the two subgroups were compared.
  
  
  RESULTS
  Elderly patients had a higher cardiovascular risk burden and a higher incidence of comorbidities. They were less likely to receive urgent revascularisation for acute ST-segment elevation myocardial infarction (elderly: 73.9% vs. non-elderly: 81.4%) and had longer door-to-needle time (elderly: 60 minutes vs. non-elderly: 50 minutes, p = 0.004). The rate of cardiac catheterisation was significantly lower in the elderly group across all ACS strata. Elderly patients had poorer outcomes than non-elderly patients, but those who received invasive treatment appeared to have better outcomes than those who received non-invasive treatment.
  
  
  CONCLUSIONS
  Elderly patients with ACS tend to be undertreated, both invasively and pharmacologically. Invasive treatment seems to yield better outcomes for this group of patients.
authors.affiliation: Department of Internal Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Ahmad Syadi Mahmood
authors.initials: AS
authors.lastname: Zuhdi
authors.affiliation: Department of Internal Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Wan Azman Wan
authors.initials: WA
authors.lastname: Ahmad
authors.affiliation: Department of Social and Preventive Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Rafdzah Ahmad
authors.initials: RA
authors.lastname: Zaki
authors.affiliation: Department of Social and Preventive Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Jeevitha
authors.initials: J
authors.lastname: Mariapun
authors.affiliation: Cardiology Unit, National Heart Institute, Kuala Lumpur, Malaysia.
authors.forename: Rosli Mohd
authors.initials: RM
authors.lastname: Ali
authors.affiliation: Department of Internal Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Norashikin Md
authors.initials: NM
authors.lastname: Sari
authors.affiliation: Department of Internal Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Muhammad Dzafir
authors.initials: MD
authors.lastname: Ismail
authors.affiliation: National Heart Association of Malaysia, Kuala Lumpur, Malaysia.
authors.forename: Sim
authors.initials: S
authors.lastname: Kui Hian
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology*; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D012042:Registries; D015996:Survival Rate / Q000639:trends
keywords: acute coronary syndrome; cardiovascular; elderly; mortality; percutaneous coronary intervention