European Heart Journal Advance Access originally published online on April 2, 2008
European Heart Journal 2008 29(10):1275-1282; doi:10.1093/eurheartj/ehn124
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Management and 6-month outcomes in elderly and very elderly patients with high-risk non-ST-elevation acute coronary syndromes: The Global Registry of Acute Coronary Events
1 Department of Cardiology, Waikato Hospital, Hamilton, New Zealand
2 University of Massachusetts Medical School, Worcester, MA, USA
3 Christchurch School of Medicine, Christchurch, New Zealand
4 University of Michigan Medical Center, Ann Arbor, MI, USA
5 Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
6 Concord Hospital, Sydney, Australia
Received 24 July 2007; revised 15 February 2008; accepted 29 February 2008; online publish-ahead-of-print 2 April 2008.
* Corresponding author. Tel: +64 7 8398899, Fax: +64 7 8398760, Email: devling{at}waikatodhb.govt.nz
See page 1213 for the editorial comment on this article (doi:10.1093/eurheartj/ehn184)
Aims: To test the hypothesis that increasing age in patients presenting with high-risk non-ST-segment elevation acute coronary syndromes (NSTE-ACS) does not adversely influence the benefit of an early invasive strategy on major adverse events at 6 months.
Methods and results: We report clinical outcomes in young (<70), elderly (70–80), and very elderly (>80 years) patients with high-risk NSTE-ACS enrolled in GRACE between 1999 and 2006. Six month data were available in 18 466 patients (27% elderly, 16% very elderly). Elderly and very elderly patients were less likely to receive evidence-based treatments at discharge and had a longer hospital stay (6 vs. 5 days). Angiography was performed more frequently in younger patients (67 vs. 33% in very elderly, 55% in elderly; P < 0.0001). Multiple logistic regression analysis confirmed the benefit of revascularization on the primary study endpoint (6-month stroke, death, myocardial infarction) in young [odds ratio (OR) 0.69, 95% confidence interval (CI) 0.56–0.86], elderly (0.60, 0.47–0.76), and very elderly (0.72, 0.54–0.95) patients. Revascularization was associated with reductions in 6-month mortality (OR 0.52, 95% CI 0.37–0.72 in young; 0.38, 0.26–0.54 in elderly; 0.68, 0.49–0.95 in very elderly). Stroke risk in hospital or at 6 months was not increased by revascularization.
Conclusion: Following presentation with high-risk NSTE-ACS, an evidence-based approach to management was noted less frequently with advancing patient age. Angiography, in particular, was less likely to be undertaken. Revascularization, however, when performed, was associated with significant benefits at 6 months, independent of age, and did not increase risk of stroke.
Key Words: Acute coronary syndrome • Revascularization • Elderly
CiteULike 
Connotea 
Del.icio.us What's this?
Related articles in EHJ:
- Acute coronary syndrome in the elderly
- Christiaan J. M. Vrints
EHJ 2008 29: 1213-1214.[Extract] [FREE Full Text]
This article has been cited by other articles:
|
|
 |
|
  R. D. Lopes, K. P. Alexander, S. V. Manoukian, M. E. Bertrand, F. Feit, H. D. White, C. V. Pollack Jr, J. Hoekstra, B. J. Gersh, G. W. Stone, et al. Advanced Age, Antithrombotic Strategy, and Bleeding in Non-ST-Segment Elevation Acute Coronary Syndromes: Results From the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) Trial J. Am. Coll. Cardiol., March 24, 2009; 53(12): 1021 - 1030. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. P. Giugliano and E. Braunwald The Year in Non-ST-Segment Elevation Acute Coronary Syndrome J. Am. Coll. Cardiol., September 23, 2008; 52(13): 1095 - 1103. [Full Text] [PDF]
|
|
|
|
 |
|
 C. J. M. Vrints Acute coronary syndrome in the elderly Eur. Heart J., May 2, 2008; 29(10): 1213 - 1214. [Full Text] [PDF]
|
|