[Non-ST elevation acute coronary syndrome: CRAC register experience]
R Hakim1, C Thuaire1, C Saint-Etienne2
1Service de cardiologie, les hôpitaux de Chartres, Chartres, France.
Insights
Nonagenarians with non-ST elevation acute coronary syndrome (ACS) exhibit more severe coronary artery disease and worse outcomes. This study highlights the increased risks and specific characteristics of ACS in the oldest patient population.
Area of Science:
- Cardiology
- Geriatric Medicine
- Clinical Research
Background:
- Non-ST elevation acute coronary syndrome (ACS) is a critical cardiovascular event.
- Understanding the unique clinical profiles of elderly patients with ACS is essential for tailored treatment strategies.
Purpose of the Study:
- To compare clinical, angiographic, therapeutic, and prognostic features of nonagenarians (≥90 years) with non-ST elevation ACS against younger patients.
- To identify specific challenges and outcomes in the nonagenarian ACS population.
Main Methods:
- Utilized the CRAC registry (2014-2017) database from 6 catheterization laboratories.
- Selected patients with positive-troponin non-ST elevation ACS for epidemiological and procedural data.
- Analyzed antiplatelet therapy, and hospital/one-year follow-up data for patients from the 2014-2015 period.
Main Results:
- 133 nonagenarians (2.2%) were identified among 5,964 patients with non-ST elevation ACS.
- Nonagenarians had higher rates of arterial hypertension, prior coronary angioplasty, multivessel disease, and left main disease.
- Higher one-year stroke, hospital, and one-year mortality rates were observed in nonagenarians.
Conclusions:
- Nonagenarians with positive-troponin non-ST elevation ACS present with more complex coronary artery disease.
- This elderly cohort experiences a significantly poorer prognosis compared to younger individuals.
Purpose:
To compare the clinical, angiographic, therapeutic and prognostic characteristics of nonagenarians presenting with non-ST elevation acute coronary syndrome with those of patients under 90 years of age.
Methods:
We used the CRAC register database including 6 catheterization laboratories in the Center Val-de-Loire region. Only patients with positive-troponin non-ST elevation ACS included in the registry from 2014 to 2017 were selected for epidemiological and procedural data. Regarding antiplatelet therapy, hospital and one-year follow-up data, only patients in the 2014-2015 period were analyzed.
Results:
From January 1st, 2014 to December 31st, 2017, 5.964 patients with a positive-troponin non-ST ACS, including 133 nonagenarians (2.2%) were included in the CRAC registry. Arterial hypertension and the history of coronary angioplasty were more common among nonagenarians. They present more multivessel and left main disease. The use of the bare metal stent was predominant in 2014-2015 and then became marginal in 2016-2017. Clopidogrel was the most widely used anti platelet and more than one in two nonagenarians remain on dual therapy after 12 months. One-year stroke and hospital and one-year mortality were higher in this age group.
Conclusions:
Nonagenarians with a positive-troponin non-ST elevation ACS have more severe coronary artery disease and a poorer prognosis than those younger than 90 years of age.
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