In-hospital outcome in octogenarians with acute coronary syndrome undergoing emergent coronary angiography
Kotaro Oe1, Masami Shimizu, Hidekazu Ino
1Division of Cardiovascular Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
Insights
Elderly patients over 80 with acute coronary syndrome (ACS) face higher in-hospital mortality despite similar intervention success rates. Impaired hemodynamics, not fewer risk factors, likely contribute to this increased mortality in octogenarians with ACS.
Area of Science:
- Cardiology
- Geriatric Medicine
- Clinical Outcomes Research
Background:
- Very elderly patients exhibit higher mortality rates post-acute coronary syndrome (ACS).
- Mechanisms linking advanced age to increased ACS mortality are not fully understood.
- Efficacy and safety of invasive procedures for octogenarians with ACS require further investigation.
Purpose of the Study:
- To compare clinical characteristics and in-hospital outcomes of octogenarians versus younger patients with ACS.
- To evaluate the impact of age on outcomes following emergent coronary angiography.
Main Methods:
- Retrospective comparison of 193 octogenarians (mean age 83) with 1,462 younger patients (mean age 64) undergoing emergent coronary angiography for ACS.
- Analysis of clinical characteristics, comorbidities, interventions (percutaneous transluminal coronary angioplasty [PTCA], coronary artery bypass grafting [CABG]), procedural success, and in-hospital mortality.
- Multivariate analysis to identify predictors of in-hospital mortality.
Main Results:
- Octogenarians had higher rates of female sex, cerebrovascular disease, multivessel disease, higher Killip and Forrester classes, and fewer traditional risk factors (smoking, diabetes, hypercholesterolemia).
- Intervention rates (PTCA, CABG) were similar, with comparable procedural success rates between groups.
- In-hospital mortality was significantly higher in octogenarians (19.2%) compared to younger patients (6.9%).
- Higher Killip and Forrester classes were predictors of in-hospital mortality in octogenarians.
Conclusions:
- Octogenarians with ACS present with different clinical profiles and more impaired hemodynamics than younger patients.
- Despite similar procedural success, octogenarians experience substantially higher in-hospital mortality.
- Impaired myocardial reserve is a likely contributor to increased mortality in very elderly patients with ACS.
Abstract:
Very elderly patients have higher mortality rates than younger patients after acute coronary syndrome (ACS). However, the mechanism by which increasing age contributes to such mortality remains unclear. In addition, the efficacy and safety of invasive coronary procedures for octogenarians with ACS have not been well established. We compared the clinical characteristics and in-hospital outcome of 193 octogenarians (mean age, 83 years) with those of 1,462 younger patients (mean age, 64 years) with ACS who underwent emergent coronary angiography. Octogenarians included a greater number of females, had higher rates of cerebrovascular disease and multivessel disease, a higher Killip class, a higher Forrester class, and lower rates of smoking, diabetes, and hypercholesterolemia than the younger subjects. Interventions, including percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG), were performed less frequently in octogenarians than in younger patients (88.0% versus 90.8%). The procedural success rate in octogenarians did not differ from that in younger patients. However, the in-hospital mortality rate for the octogenarians was about three times higher than for the younger patients (19.2% versus 6.9%). Multivariate analysis revealed that the predictors of in-hospital mortality in the octogenarians were a higher Killip class and a higher Forrester class. Octogenarians with ACS had fewer coronary risk factors and a similar success rate for the intervention, but had more greatly impaired hemodynamics and higher in-hospital mortality than the younger patients. Therefore, impaired myocardial reserve may contribute to a large portion of in-hospital deaths in octogenarians with ACS.
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