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

ObjectiveTo characterize risk profile of acute coronary syndrome (ACS) patients in different age groups and compare management provided to in-hospital outcome.DesignProspective multi-hospital registry.SettingSeventeen secondary and tertiary care hospitals in Saudi Arabia.PatientsFive 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).ConclusionsYoung 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.