Early invasive strategy in patients over 75 years with acute coronary syndrome. A single center study

Abstract

Objective: to assess the clinical status, comorbidities, complications, in-hospital mortality and its structure in dependence of age and type of acute coronary syndrome (ACS) in case of early invasive strategy of ACS management. Materials and methods: we included in this retrospective study data of all patients (n=1353) with ACS subjected to emergency and urgent myocardial revascularization in High Medical Technologies Center (Kaliningrad, Russia) in 2014-2016. Age of 984 patients was <75 (group 1) and of 369 ≥75 years (group 2). Results. Mean age was 60±8.6 and 80.1±4.2 years, in groups 1 and 2, respectively. Anamnesis of group 2 patients was substantially burdened by myocardial infarction and stroke, they significantly more often had reduced left ventricular ejection fraction (EF), congestive heart failure, valve disorders, and atrial fibrillation. Patients of group 2 more frequently had severe manifestations of acute heart failure (AHF) and cardiogenic shock. Portions of patients with Killip class III were 5.9 and 11.4 %, IV - 2.1 % and 9.1 % in 1 and 2, respectively. Group 2 patients compared with those of group 1 had higher GRACE score and higher bleeding risk. In-hospital all-cause mortality was 3.1 and 10 %, ST elevation myocardial infarction mortality - 2.6 and 9.5 % in groups 1 and 2, respectively. Non-ST elevation myocardial infarction + unstable angina mortality (0.5 %) did not differ between groups. Mortality from AHF (2 and 6.5 %) and percutaneous coronary intervention complications (stent thrombosis and no-reflow) (0.5 and 2.4 %) was significantly higher in group 2. AHF mortality was similar in patients with preserved and mid-range EF of both groups, but among those with reduced EF it was significantly higher in group 2 compared with group 1 (7.3 vs. 18.6 %, respectively). There were no significant differences between groups in rates of gastro-intestinal and major bleedings. Conclusions. Clinical course of ACS was more severe in patients aged ≥75 years compared with patients aged <75 years. Early invasive strategy was effective irrespective of patient's age and ACS type. Rate of fatal outcomes due to complications of stenting and AHF were higher among very elderly patients. AHF more often caused death in very elderly patients with reduced EF. The rest of the structure of complications and mortality was similar in patients of different ages.