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CLINICAL RESEARCH: CORONARY ARTERY DISEASE

Importance of increasing age on the presentation and outcome of acute coronary syndromes in elderly patients

^* Department of Cardiology, Lady Davis Carmel Medical Center, Bruce Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel

Manuscript received June 25, 2003; revised manuscript received August 6, 2003, accepted August 18, 2003.

^* Reprint requests and correspondence: Dr. David A. Halon, Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7, Michal Street, Haifa 34362, Israel.
halon{at}clalit.org.il

OBJECTIVES: The study examined differences in presentation and outcome between elderly (70 years) and very elderly (80 years) patients hospitalized for acute coronary syndromes (ACS).

BACKGROUND: The elderly constitute an increasingly important sector of patients with ACS but have been underrepresented in many therapeutic trials.

METHODS: We compiled a registry of 449 consecutive patients, 251 elderly (70 to 79 years) (septuagenarians, group 1) and 198 very elderly (80 years) (group 2), to examine outcomes in relation to baseline characteristics and treatment. We recorded survival over a period of 24 ± 4 months and rehospitalization and symptomatic status at 16 ± 4 months.

RESULTS: At index hospitalization, the older cohort (group 2) more often had acute myocardial infarction (35% vs. 9.7%, p < 0.0001), heart failure (33.3% vs. 19.4%, p < 0.001), and renal dysfunction (21.6% vs. 12.3%, p = 0.01). They were less likely to undergo coronary angiography (29.3% vs. 43.8%, p = 0.002), but those selected for angiography more often underwent revascularization so that revascularization rates were similar (22.7% group 2 vs. 24.3% group 1, p = NS). Two-year survival rate was poorer in group 2 (67.4 ± 3.5% vs. 83.5 ± 2.5% in group 1, p < 0.0001). Repeat rehospitalization was similar (53.0% vs. 48.2%, respectively, p = 0.31), but improvement in well-being of survivors was greater (60.0% vs. 46.3%, p = 0.01).

CONCLUSIONS: The study demonstrated important differences between elderly (70 to 79 years) and very elderly (80 years) patients hospitalized with ACS. The older cohort was sicker on admission and had poorer outcome, but a subgroup selected for angiography and possible intervention had two-year outcomes similar to the younger cohort.

Abbreviations and Acronyms   ACS = acute coronary syndromes   AMI = acute myocardial infarction   CAD = coronary artery disease   CPK = creatine phosphokinase   HF = heart failure   HR = hazard ratio   NYHA = New York Heart Association   PCI = percutaneous coronary intervention

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