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Acute coronary syndromes in octogenarians referred for invasive evaluation: treatment profile and outcomes


Jaguszewski, Milosz; Ghadri, Jelena-R; Diekmann, Johanna; Bataiosu, Roxana D; Hellermann, Jens P; Sarcon, Annahita; Siddique, Asim; Baumann, Lukas; Stähli, Barbara E; Lüscher, Thomas F; Maier, Willibald; Templin, Christian (2015). Acute coronary syndromes in octogenarians referred for invasive evaluation: treatment profile and outcomes. Clinical Research in Cardiology, 104(1):51-58.

Abstract

BACKGROUND With increasing life expectancy in the western world, the aging population will compose a significant portion of the demographic. Notably, cardiovascular disease is particularly prevalent in the elderly population. The aim of the present study is to investigate the outcomes of octogenarians referred for urgent coronary angiography in the setting of acute coronary syndromes (ACS). METHODS Between June 2007 and June 2012, consecutive patients with ACS were referred for evaluation and percutaneous intervention. Subsequently, the in-hospital death and major adverse cardiovascular events (MACE) at 30 days were analyzed. Multivariate analysis was performed to identify the predictors for death and MACE. RESULTS In patients ≥80 years (n = 296) ST-segment elevation myocardial infarction (STEMI) occurred in 46.6 %, non-ST-segment elevation myocardial infarction (NSTEMI) in 45.9 %, and 7.4 % had unstable angina. On the other hand, in patients <80 years (n = 2,316) STEMI was observed in 53.4 %, NSTEMI in 37.8 % and unstable angina in 9.0 %. The primary end-point of total mortality was significantly higher in octogenarians (7.4 vs. 4.5 %, p = 0.026). Similarly, the secondary end-point comprising overall MACE rate was significantly higher among the elderly (12.5 vs. 7.3 %, p = 0.002). Within the group of octogenarians, no relation between age and outcomes was noted (for death: OR 0.99, 95 % CI 0.84-1.16, p = 0.915; and for MACE: OR 1.10, 95 % CI 0.88-1.36, p = 0.412); however, in patients <80 years, age was related to outcomes (for death: OR 1.05, 95 % CI, 1.02-1.08, p = 0.003; and for MACE: OR 1.03, 95 % CI, 1.01-1.05, p = 0.011). In a multivariate analysis, systolic blood pressure (OR 0.97 95 % CI 0.94-0.99, p = 0.0058), maximal value of creatine kinase (OR 1.00, 95 % CI 1.00-1.00, p = 0.033), and maximal value of NT-proBNP (OR 1.00, 95 % CI 1.00-1.00, p = 0.0225) were independent predictors for death, while systolic blood pressure (OR 0.98, 95 % CI 0.96-0.99, p = 0.0384) and maximal value of C-reactive protein (OR 1.01, 95 % CI 1.00-1.01, p = 0.0265) were associated with overall MACE. CONCLUSIONS Here we confirm that in-hospital death and MACE rate remain significantly elevated in octogenarians in spite of implementation of modern therapies. However, our real-world registry strongly suggests that early revascularization appears safe and effective in elderly patients. Furthermore, we have identified that systolic blood pressure, creatine kinase, NT-proBNP, and C-reactive protein are strong predictors for outcomes in octogenarians.

Abstract

BACKGROUND With increasing life expectancy in the western world, the aging population will compose a significant portion of the demographic. Notably, cardiovascular disease is particularly prevalent in the elderly population. The aim of the present study is to investigate the outcomes of octogenarians referred for urgent coronary angiography in the setting of acute coronary syndromes (ACS). METHODS Between June 2007 and June 2012, consecutive patients with ACS were referred for evaluation and percutaneous intervention. Subsequently, the in-hospital death and major adverse cardiovascular events (MACE) at 30 days were analyzed. Multivariate analysis was performed to identify the predictors for death and MACE. RESULTS In patients ≥80 years (n = 296) ST-segment elevation myocardial infarction (STEMI) occurred in 46.6 %, non-ST-segment elevation myocardial infarction (NSTEMI) in 45.9 %, and 7.4 % had unstable angina. On the other hand, in patients <80 years (n = 2,316) STEMI was observed in 53.4 %, NSTEMI in 37.8 % and unstable angina in 9.0 %. The primary end-point of total mortality was significantly higher in octogenarians (7.4 vs. 4.5 %, p = 0.026). Similarly, the secondary end-point comprising overall MACE rate was significantly higher among the elderly (12.5 vs. 7.3 %, p = 0.002). Within the group of octogenarians, no relation between age and outcomes was noted (for death: OR 0.99, 95 % CI 0.84-1.16, p = 0.915; and for MACE: OR 1.10, 95 % CI 0.88-1.36, p = 0.412); however, in patients <80 years, age was related to outcomes (for death: OR 1.05, 95 % CI, 1.02-1.08, p = 0.003; and for MACE: OR 1.03, 95 % CI, 1.01-1.05, p = 0.011). In a multivariate analysis, systolic blood pressure (OR 0.97 95 % CI 0.94-0.99, p = 0.0058), maximal value of creatine kinase (OR 1.00, 95 % CI 1.00-1.00, p = 0.033), and maximal value of NT-proBNP (OR 1.00, 95 % CI 1.00-1.00, p = 0.0225) were independent predictors for death, while systolic blood pressure (OR 0.98, 95 % CI 0.96-0.99, p = 0.0384) and maximal value of C-reactive protein (OR 1.01, 95 % CI 1.00-1.01, p = 0.0265) were associated with overall MACE. CONCLUSIONS Here we confirm that in-hospital death and MACE rate remain significantly elevated in octogenarians in spite of implementation of modern therapies. However, our real-world registry strongly suggests that early revascularization appears safe and effective in elderly patients. Furthermore, we have identified that systolic blood pressure, creatine kinase, NT-proBNP, and C-reactive protein are strong predictors for outcomes in octogenarians.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology
Dewey Decimal Classification:610 Medicine & health
Date:January 2015
Deposited On:05 Feb 2015 08:22
Last Modified:08 Dec 2017 11:31
Publisher:Springer
ISSN:1861-0684
Publisher DOI:https://doi.org/10.1007/s00392-014-0756-5
PubMed ID:25142902

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