Long-term major adverse cardiovascular events and quality of life after coronary angiography in elderly patients with acute coronary syndrome

BackgroundAlthough the elderly comprise the majority of acute coronary syndrome (ACS) patients, limited data exist on major adverse cardiovascular events (MACEs) and quality of life (QoL).ObjectivesTo study MACEs and QoL prospectively in ACS patients > 70 years referred for coronary angiography.MethodsA prospective observational study that included ACS patients > 70 years undergoing coronary angiography. The outcomes were MACEs and QoL 3 years after inclusion. MACEs were defined as death, recurrent ACS, new-onset of heart failure and repeated revascularization by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). A QoL questionnaire was completed by the patients along with a physical examination and a personal interview at the 3-year follow-up. Multivariate analysis was performed to identify the predictors for MACEs.ResultsIn total, 138 patients (mean age 78.8 ± 3.8 years) with ACS were included in the study. Mean follow-up was 1196 ± 296 days. In all, 42% of the patients had MACEs and 25% had post-ACS heart failure. The mortality rate was 11%. After adjusting for significant cardiovascular risk factors, the following factors were significantly associated with MACEs: Age, high-sensitive troponin T (hsTNT), use of diuretics and reduced left ventricular ejection fraction (LVEF). Furthermore, the QoL evaluated with SF-36 in survivors from ACS at the end of study was similar to the QoL in an age-matched healthy Swedish population.ConclusionsIn this prospective study on elderly ACS patients MACEs still occurred in 42% of the cases (despite low mortality and good QoL), with post-ACS heart failure as the most important event.