A systematic invasive strategy in non-ST elevation acute coronary syndromes: is age a limiting factor?

A systematic invasive therapeutic strategy for acute coronary syndromes (ACS) is currently accepted as safe and effective and evidence is growing for its superiority compared to a conservative attitude. Elderly patients, given their greater susceptibility, are frequently excluded from this approach, and this may limit the potential benefits.

To evaluate the influence of age on the characteristics and clinical evolution of patients with ACS treated by an invasive strategy and to determine whether this in itself limits its adoption.

We retrospectively studied 203 patients admitted for ACS (consecutive and non-selected). considered of medium to high risk after evaluation and treated with glycoprotein IIb/IIIa receptor inhibitors. Of these, 45 patients were aged > or =75 years and they constituted the Elderly group, the remainder constituting the Non-elderly group. Their baseline characteristics, treatment and clinical evolution were analyzed and compared.

The Elderly group had more women, although the difference was not statistically significant. Of the other characteristics studied, family history of coronary disease and smoking presented significant differences, both being less frequent among the elderly. There was a non-significant tendency to perform less catheterization in the elderly, the two groups being similar regarding the revascularization therapy chosen. Overall, hemorrhagic complications were more frequent in the Elderly group, but the difference regarding significant hemorrhages did not reach statistical significance. In-hospital mortality was higher in the elderly, but diminished and did not reach statistical significance when only patients in whom catheterization was performed were considered.

In this population the elderly had more non-significant hemorrhagic complications but their higher in-hospital mortality was not associated with the adoption of an invasive approach. We therefore suggest that age by itself does not limit the adoption of a systematic invasive strategy.