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

OBJECTIVES The study examined differences in presentation and outcome between elderly ( greater than or equal to70 years) and very elderly ( greater than or equal to80 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 ( greater than or equal to80 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. (c) 2004 by the American College of Cardiology Foundation.