Importance of increasing age on the presentation and outcome of acute coronary syndromes in elderly patients

The study examined differences in presentation and outcome between elderly (≥70 years) and very elderly (≥80 years) patients hospitalized for acute coronary syndromes (ACS). The elderly constitute an increasingly important sector of patients with ACS but have been underrepresented in many therapeutic trials. We compiled a registry of 449 consecutive patients, 251 elderly (70 to 79 years) (septuagenarians, group 1) and 198 very elderly (≥80 years) (group 2), to examine outcomes in relation to baseline characteristics and treatment. We recorded survival over a period of 24 ± 4 months and rehospitalization and symptomatic status at 16 ± 4 months. At index hospitalization, the older cohort (group 2) more often had acute myocardial infarction (35% vs. 9.7%, p < 0.0001), heart failure (33.3% vs. 19.4%, p < 0.001), and renal dysfunction (21.6% vs. 12.3%, p = 0.01). They were less likely to undergo coronary angiography (29.3% vs. 43.8%, p = 0.002), but those selected for angiography more often underwent revascularization so that revascularization rates were similar (22.7% group 2 vs. 24.3% group 1, p = NS). Two-year survival rate was poorer in group 2 (67.4 ± 3.5% vs. 83.5 ± 2.5% in group 1, p < 0.0001). Repeat rehospitalization was similar (53.0% vs. 48.2%, respectively, p = 0.31), but improvement in well-being of survivors was greater (60.0% vs. 46.3%, p = 0.01). The study demonstrated important differences between elderly (70 to 79 years) and very elderly (≥80 years) patients hospitalized with ACS. The older cohort was sicker on admission and had poorer outcome, but a subgroup selected for angiography and possible intervention had two-year outcomes similar to the younger cohort.