Acute coronary syndrome in elderly - What is the place for invasive strategy?

BackgroundThe elderly are less likely to undergo an invasive strategy for acute coronary syndrome (ACS). The aim is to determine the predictors for an invasive strategy and to evaluate the revascularization effect on outcome.MethodsRetrospective analysis of ACS patients (P) with ≥80 years, admitted between 2010 and 2014, in a national ACS registry. P were divided in intervened (G1) and non-intervened (G2) groups. We determined predictors for an invasive approach - percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) - and compared the one year outcome between groups.ResultsFrom 11,113P admitted with ACS, 2014 had ≥80 years. 1025P were included in G1. Predictors for an invasive strategy were STEMI (OR 4.97; P < 0.001), previous PCI (OR 2.02; P < 0.001), sinus rhythm (OR 1.56; P = 0.002), haemoglobin at admission (OR 1.10; P = 0.003). Predictors of no intervention were female gender (OR 0.68; P = 0.002), previous ACS (OR0.67; P = 0.013), previous CABG (OR 0.60; P = 0.035), heart failure (OR 0.48; P < 0.001), stroke (OR 0.58; P = 0.002), dementia (OR 0.28; P < 0.001), heart rate (OR 0.99; P < 0.003) and ejection fraction < 50% (OR 0.68; P = 0.001). Hospital mortality was inferior in G1 (8.3% vs. 13.6%; P < 0.001), being conservative strategy (HR 2.63; P < 0.001), STEMI (HR 2.11; P = 0.001), dementia (HR 2.08; P = 0.021), inotropics (HR 9.82; P < 0.001) and ejection fraction <50% (HR 2.65; P < 0.001) predictors of mortality. In propensity score analysis, at one year follow up G1 had a better survival (88.9% vs. 79.6%; P < 0.001).ConclusionIn elderly patients with ACS, an invasive strategy was associated with short and long-term survival advantage. The predictors for invasive intervention are STEMI, previous PCI, sinus rhythm and haemoglobin at admission.