[Prognostic impact of interventional approach in non-ST segment elevation acute coronary syndrome in very elderly
Iñaki Villanueva-Benito1, Itziar Solla-Ruíz, Emilio Paredes-Galán
1Servicio de Cardiología, Complejo Hospitalario Universitario de Vigo, Hospital Meixoeiro, Vigo, Pontevedra, España. ivillanu@hotmail.com
Insights
The interventional approach improved survival for very elderly patients with non-ST segment elevation acute coronary syndrome. This cardiac intervention showed better survival and fewer ischemic events in patients over 85 years old.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Clinical guidelines recommend coronary angiography for non-ST segment elevation acute coronary syndrome (NSTE-ACS) in moderate to high-risk patients.
- Evidence supporting revascularization in very elderly patients (over 85) with NSTE-ACS is limited.
Purpose of the Study:
- To evaluate the effectiveness of an interventional approach versus conservative management in very elderly patients with NSTE-ACS.
- To compare survival rates and survival free of ischemic events in this patient population.
Main Methods:
- Retrospective study of patients over 85 admitted with NSTE-ACS between 2004-2009.
- Propensity score matching was used to compare patients undergoing interventional procedures with those receiving conservative management.
- Survival and freedom from ischemic events were assessed at 3-year follow-up.
Main Results:
- The interventional group (n=100) had better 3-year survival (P=.039) and survival free of ischemic events (P=.003) compared to the conservative group (n=128) in propensity score-matched patients (n=63 vs 63).
- In the overall population, the interventional approach was associated with significantly lower mortality (HR 0.52) and better survival free of ischemic events (HR 0.48).
- Nearly all very elderly patients with NSTE-ACS were found to be at moderate or high risk.
Conclusions:
- The interventional approach in very elderly patients (over 85) with NSTE-ACS is associated with improved survival outcomes.
- This approach also leads to better survival free of ischemic events in this vulnerable population.
- Findings suggest that revascularization strategies should be considered for very elderly patients with NSTE-ACS.
Introduction And Objectives:
In moderate or high risk non-ST segment elevation acute coronary syndrome, clinical practice guidelines recommend a coronary angiography with intent to revascularize. However, evidence to support this recommendation in very elderly patients is poor.
Methods:
All patients over 85 years old admitted to our hospital between 2004 and 2009 with a diagnosis of non-ST segment elevation acute coronary syndrome were retrospectively included. Using a propensity score, patients undergoing the interventional approach and those undergoing conservative management were matched and compared for survival and survival without ischemic events.
Results:
We included 228 consecutive patients with a mean age of 88 years (range: 85 to 101). Those in the interventional approach group (n=100) were younger, with a higher proportion of males and less comorbidity, less cognitive impairment and lower troponin I levels compared with patients in the conservative management group (n=128). We matched 63 patients from the interventional approach group and 63 from the conservative management group using propensity score. In the matched patients, the interventional approach group exhibited better survival (log rank 4.24; P=.039) and better survival free of ischemic events (log rank 8.63; P=.003) at the 3-year follow-up. In the whole population, adjusted for propensity score quintiles, the interventional approach group had lower mortality (hazard ratio 0.52; 95% confidence interval: 0.32-0.85) and a better survival free of ischemic events (hazard ratio 0.48; 95% confidence interval: 0.32-0.74).
Conclusions:
Nearly all the very elderly patients admitted with non-ST segment elevation acute coronary syndrome were of moderate or high risk. In these patients, the interventional approach was associated with overall better survival and better survival free of ischemic events.
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