[Acute coronary syndromes in patients over 80 years old]
Józefa Dabek1, Daniel Jakubowski, Zbigniew Gasior
1Slska Akademia Medyczna w Katowicach, Katedra i Klinika Kardiologii.
Insights
This study investigated acute coronary syndrome (ACS) in patients over 80. Right coronary artery occlusion was a common culprit lesion, with higher cardiac enzymes in deceased patients.
Area of Science:
- Cardiology
- Geriatric Medicine
- Internal Medicine
Background:
- Atherosclerosis is a chronic, progressive disease.
- Advanced atherosclerosis is prevalent in the elderly population.
Purpose of the Study:
- To examine patients over 80 years old admitted with acute coronary syndrome (ACS).
- To analyze clinical characteristics and outcomes in this elderly cohort.
Main Methods:
- Studied 50 patients (80-93 years) with <12-hour ACS symptoms.
- Utilized ECG, echocardiography, laboratory tests, and coronary angiography.
- Assessed infarct site, lesion localization, cardiac enzymes, LV ejection fraction, and renal insufficiency.
Main Results:
- Six patients expired, with higher mean age and cardiac enzymes.
- Right coronary artery occlusion was the primary culprit lesion in most cases.
- Compared outcomes across ST-elevation, NSTEMI, and unstable angina groups.
Conclusions:
- Right coronary artery revascularization may be considered for elderly patients with multi-vessel disease unsuitable for surgery.
- Highlights the challenges and specific considerations in managing ACS in the very elderly.
Unlabelled:
Atherosclerosis is regarded as a chronic disease. Because of its progressive character the most advanced cases of atherosclerosis are expected to be found in elderly population.
Aim Of The Study:
We decided to take a closer look at a population of patients above 80 years of age who were admitted to our Center because of ACS.
Material And Methods:
Included in our study were 50 consecutive cases of patients admitted with less than 12-hour history of symptoms of ACS . Their age ranged from 80 to 93 years with a mean of 82 years. All patients were subjected to: complete history and physical examination, 12-lead ECG, 2-D Echocardiography and laboratory studies including CPK, CK-MB, lipid profile, glucose and creatinine level. In the researched group 44 patients underwent coronary angiography and 32 of them required PTCA. Six patients in the group managed with invasive studies subsequently expired. Patients were analyzed in respect to: infarct site, coronary vessel lesion localization, cardiac enzymes levels, LV ejection fraction and renal insufficiency. We also compared groups with ST segment elevations, NSTEMI and unstable angina. Separately analysis of a group of deceased patients was conducted.
Results:
Six of our patients expired. Their mean age was higher than of the whole group. They also presented with significantly higher levels of cardiac enzymes. In majority of cases right coronary artery occlusion was found to be the culprit lesion.
Conclusion:
Therefore, in complicated cases of elderly with multi-vessel atherosclerotic changes not qualifying for surgical revascularisation attempts to improve blood supply in the territory of the RCA might be considered.
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