Outcomes of Elderly Patients with ST-Elevation or Non-ST-Elevation Acute Coronary Syndrome Undergoing Percutaneous
Nuccia Morici1, Stefano Savonitto2, Luca A Ferri2
1Unità di Cure Intensive Cardiologiche; ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy; Department of Clinical Sciences and Community Health Università degli Studi di Milano, Milano, Italy.
Insights
Elderly patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention have worse survival and higher stroke risk than those with non-ST-elevation ACS (NSTEACS), despite better baseline health.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Acute coronary syndromes (ACS) management differs based on ST-segment elevation on ECG.
- Limited comparative data exists for elderly ACS patients undergoing percutaneous coronary intervention (PCI).
Purpose of the Study:
- To compare clinical characteristics and outcomes of elderly patients (>75 years) with ST-elevation myocardial infarction (STEMI) versus non-ST-elevation ACS (NSTEACS) after PCI.
Main Methods:
- Retrospective cohort study of 1443 elderly ACS patients from the Elderly ACS-2 trial.
- Outcomes assessed included cardiovascular death, noncardiovascular death, reinfarction, and stroke at 12-month follow-up.
Main Results:
- STEMI patients (41%) had more favorable baseline factors but lower ejection fraction than NSTEACS patients (59%).
- STEMI patients had higher rates of cardiovascular death (8.6% vs 4.6%), noncardiovascular death, and stroke after adjusted analysis.
Conclusions:
- Elderly STEMI patients face worse survival and increased stroke risk post-PCI compared to NSTEACS patients.
- These findings highlight the need for tailored management strategies for elderly STEMI patients.
Introduction:
Acute coronary syndromes (ACS) have been classified according to the finding of ST-segment elevation on the presenting electrocardiogram, with different treatment strategies and practice guidelines. However, a comparative description of the clinical characteristics and outcomes of acute coronary syndrome elderly patients undergoing percutaneous coronary intervention during index admission has not been published so far.
Methods:
Retrospective cohort study of patients enrolled in the Elderly ACS-2 multicenter randomized trial. Main outcome measures were crude cumulative incidence and cause-specific hazard ratio (cHR) of cardiovascular death, noncardiovascular death, reinfarction, and stroke.
Results:
Of 1443 ACS patients aged >75 years (median age 80 years, interquartile range 77-84), 41% were classified as ST-elevation myocardial infarction (STEMI), and 59% had non-ST-elevation ACS (NSTEACS) (48% NSTEMI and 11% unstable angina). As compared with those with NSTEACS, STEMI patients had more favorable baseline risk factors, fewer prior cardiovascular events, and less severe coronary disease, but lower ejection fraction (45% vs 50%, P < .001). At a median follow-up of 12 months, 51 (8.6%) STEMI patients had died, vs 39 (4.6%) NSTEACS patients. After adjusting for sex, age, and previous myocardial infarction, the hazard among the STEMI group was significantly higher for cardiovascular death (cHR 1.85; 95% confidence interval [CI], 1.02-3.36), noncardiovascular death (cHR 2.10; 95% CI, 1.01-4.38), and stroke (cHR 4.8; 95% CI, 1.7-13.7).
Conclusions:
Despite more favorable baseline characteristics, elderly STEMI patients have worse survival and a higher risk of stroke compared with NSTEACS patients after percutaneous coronary intervention.
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