Age and its relationship to acute coronary syndromes in the Saudi Project for Assessment of Coronary Events (SPACE) registry: The SPACE age study

Abstract

Objective: To characterize risk profile of acute coronary syndrome (ACS) patients in different age groups and compare management provided to in-hospital outcome. Design: Prospective multi-hospital registry. Setting: Seventeen secondary and tertiary care hospitals in Saudi Arabia. Patients: Five thousand and fifty-five patients with ACS. They were divided into four groups: ≤40. years, 41-55. years, 56-70. years and ≥70. years. Main outcome measures: prevalence, utilization and mortality.Results: Ninety-four percent of patients <40. years compared to 68% of patients >70. years were men. Diabetes was present in 70% of patients aged 56-70. years. Smoking was present in 66% of those <40. years compared to 7% of patients >70. years. Fifty-three percent of the patients >70. years and 25% of those <40. years had history of ischemic heart disease. Sixty percent of patients <40. years presented with ST elevation myocardial infarction (STEMI) while non-ST elevation myocardial infarction was the presentation in 49% of patients >70. years. Thirty-four percent of patients >70. years compared to 10% of patients <40. years presented >12. h from symptom onset with STEMI. Fifty-four percent of patients >70 compared to 64-71% of those <70. years had coronary angiography. Twenty-four percent of patients >70 compared to 34-40% of those <70. years had percutaneous coronary intervention. Reperfusion shortfall for STEMI was 16-18% in patients >56. years compared to 11% in patients <40. years. Mortality was 7% in patients >70. years compared to 1.6-3% in patients <70. years. For all comparisons (p< 0.001). Conclusions: Young and old ACS patients have unique risk factors and present differently. Older patients have higher in-hospital mortality as they are treated less aggressively. There is an urgent need for a national prevention program as well as a systematic improvement in the care for patients with ACS including a system of care for STEMI patients. For older patients there is a need to identify medical as well as social factors that influence the therapeutic management plans. © 2011.