European Heart Journal Advance Access originally published online on February 7, 2006
European Heart Journal 2006 27(7):789-795; doi:10.1093/eurheartj/ehi774
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Age, clinical presentation, and outcome of acute coronary syndromes in the Euroheart acute coronary syndrome survey
1Department of Medicine, Sahlgrenska University Hospital/Ostra, SE-416 85 Göteborg, Sweden
2University Hospital, Uppsala, Sweden
3Thoraxcenter, Rotterdam, The Netherlands
4Klinikum der Stadt Ludwigshafen, Germany
5Neufeld Cardiac Research Institute, Tel-Hashomer, Israel
6Rabin Medical Center, Petah Tikva, Israel
Received 31 August 2005; revised 9 January 2005; accepted 19 January 2006; online publish-ahead-of-print 7 February 2006.
* Corresponding author. Tel: +46 31 3434000; fax: +46 31 259254. E-mail address: annika.rosengren{at}hjl.gu.se
Aims Age is one of the most powerful determinants of prognosis in myocardial infarction, but there is comparatively little recent data across the whole spectrum of acute coronary syndromes (ACS). We examined the impact of increasing age on clinical presentation and hospital outcome in a large sample of patients with ACS.
Methods and results Patients (n=10 253) from the Euroheart ACS survey in 103 hospitals in 25 countries were investigated. There was a significant inverse association between the age and the likelihood of presenting with ST-elevation. For each decade of life, the odds of presenting with ST-elevation decreased by 0.82 [95% confidence interval (CI) 0.79–0.84]; P<0.0001. Elderly patients were considerably less often treated by cardiologists, less extensively investigated, and, when presenting with ST-elevation ACS, less likely to be treated with reperfusion. Compared with patients <55 years, the odds ratios of hospital mortality were 1.87 (1.21–2.88) at age 55–64, 3.70 (2.51–5.44) at age 65–74, 6.23 (4.25–9.14) at age 75–84, and 14.5 (9.47–22.1) among patients 
85 years, with no major differences across different types of admission or discharge diagnoses.
Conclusion Elderly ACS patients were less likely to present with ST-elevation but had substantial in-hospital mortality, yet they were markedly less intensively treated and investigated.
Key Words: Acute myocardial infarction • Unstable angina • Coronary disease • Aging
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