Short and Long-Term Clinical Outcomes in Octogenarian Patients With Non-ST-Elevation Myocardial Infarction: A
Fawaz S Baalaraj1, Mohammed E Almalki2, Mansour M Almalki1
1Medicine, Umm Al-Qura University, Makkah, SAU.
Insights
For octogenarian patients with non-ST-elevation myocardial infarction (NSTEMI), revascularization increased complications and mortality compared to medical management. Conservative therapy demonstrated better survival rates in this elderly population.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Cardiovascular disease is a leading cause of death and disability in older adults.
- Treatment decisions for elderly patients with non-ST-elevation myocardial infarction (NSTEMI) between revascularization and medical management are often controversial.
- Octogenarian patients present unique challenges in cardiovascular disease management.
Purpose of the Study:
- To compare the clinical outcomes of revascularization versus conservative medical management for octogenarian patients diagnosed with NSTEMI.
- To evaluate the short- and long-term implications of these treatment strategies in an elderly cohort.
- To provide evidence for optimizing treatment decisions in this vulnerable patient group.
Main Methods:
- An observational cohort study involving 41 octogenarian patients with NSTEMI (2019-2021).
- Patients were managed with either revascularization (PCI, CABG, or both) or conservative medical therapy.
- Comparison of short- and long-term outcomes between the 13 patients in the revascularization group and 28 in the medical therapy group.
Main Results:
- The revascularization group experienced significantly higher complication rates (84.6%) compared to the medical therapy group (46.4%).
- Mortality rates were higher in the revascularization group (short-term: 23.1%, long-term: 38.5%) versus the medical therapy group (short-term: 14.3%, long-term: 32.1%), though not statistically significant.
- The medical therapy group showed numerically better survival rates in both short- and long-term follow-up.
Conclusions:
- Revascularization in octogenarian NSTEMI patients is associated with increased complications and higher mortality compared to medical management.
- Conservative medical management appears to offer better survival rates in the short and long term for this population.
- These findings suggest a cautious approach to revascularization in very elderly patients with NSTEMI.
Introduction:
As the primary cause of morbidity and mortality among older individuals, cardiovascular disease remains a major concern. Choosing between revascularization and medical management of elderly patients remains controversial. This study aims to evaluate the clinical implications of these treatment approaches in the context of non-ST-elevation myocardial infarction (NSTEMI) in octogenarian patients.
Methods:
This observational cohort study involved 41 octogenarian patients who were diagnosed with NSTEMI from 2019 to 2021 and were managed by revascularization (with either percutaneous coronary intervention, coronary artery bypass graft surgery, or both) or conservative medical therapy. All NSTEMI patients were diagnosed based on symptoms, electrocardiographic changes, and cardiac biomarkers. The study compared the short- and long-term outcomes of 13 patients in the revascularization group and 28 in the medical therapy group.
Results:
Overall, the mean patient age was 84.63 years. Eighteen patients were men (43.9%), and 23 were women (56.1%). The most prevalent disease among the sample was hypertension (34 patients, 82.9%), followed by diabetes mellitus (27 patients, 65.9%) and prior ischemic heart disease (21 patients, 51.2%). Almost all patients in the revascularization-treated group developed complications after the procedure (84.6%), while 46.4% of the patients in the medication-only group developed a complication later on. The revascularization-treated group showed higher mortality rates in both the short- and long-term (23.1% and 38.5%, respectively) compared to the medication-only group, which showed better survival rates numerically in both the short- and long-term (14.3% and 32.1%, respectively). This was not statistically significant.
Conclusion:
Revascularization treatment in elderly patients with NSTEMI was associated with a higher risk of complications and a higher mortality rate compared with conservative medical management. Patients managed with only medications had a better survival rate in both the short- and long-term.
