American Journal of Medicine, internal medicine, medicine, health, healthy lifestyles, cancer, heart disease, drugs

Outcomes of Elderly Patients with ST-Elevation or Non-ST-Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Acute coronary syndromes (ACS) have been classified according to the finding of ST-segment elevation on the presenting electrocardiogram, with different treatment strategies and practice guidelines. However, a comparative description of the clinical characteristics and outcomes of acute coronary syndrome elderly patients undergoing percutaneous coronary intervention during index admission has not been published so far.

Methods

Retrospective cohort study of patients enrolled in the Elderly ACS-2 multicenter randomized trial. Main outcome measures were crude cumulative incidence and cause-specific hazard ratio (cHR) of cardiovascular death, noncardiovascular death, reinfarction, and stroke.

Results

Of 1443 ACS patients aged >75 years (median age 80 years, interquartile range 77-84), 41% were classified as ST-elevation myocardial infarction (STEMI), and 59% had non-ST-elevation ACS (NSTEACS) (48% NSTEMI and 11% unstable angina). As compared with those with NSTEACS, STEMI patients had more favorable baseline risk factors, fewer prior cardiovascular events, and less severe coronary disease, but lower ejection fraction (45% vs 50%, P < .001). At a median follow-up of 12 months, 51 (8.6%) STEMI patients had died, vs 39 (4.6%) NSTEACS patients. After adjusting for sex, age, and previous myocardial infarction, the hazard among the STEMI group was significantly higher for cardiovascular death (cHR 1.85; 95% confidence interval [CI], 1.02-3.36), noncardiovascular death (cHR 2.10; 95% CI, 1.01-4.38), and stroke (cHR 4.8; 95% CI, 1.7-13.7).

Conclusions

Despite more favorable baseline characteristics, elderly STEMI patients have worse survival and a higher risk of stroke compared with NSTEACS patients after percutaneous coronary intervention.

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-Nuccia Morici, MD, Stefano Savonitto, MD, Luca A. Ferri, MD, Daniele Grosseto, MD, Irene Bossi, MD, Paolo Sganzerla, MD, Giovanni Tortorella, MD, Michele Cacucci, MD, Maurizio Ferrario, MD, Gabriele Crimi, MD, Ernesto Murena, MD, Stefano Tondi, MD, Anna Toso, MD, Nicola Gandolfo, MD, Amelia Ravera, MD, Elena Corrada, MD, Matteo Mariani, MD, Leonardo Di Ascenzo, MD, A. Sonia Petronio, MD, Claudio Cavallini, MD, Giancarlo Vitrella, MD, Roberto Antonicelli, MD, Federico Piscione, MD, Renata Rogacka, MD, Laura Antolini, Gianfranco Alicandro, PhD, Carlo La Vecchia, Luigi Piatti, MD, Stefano De Servi, MD Elderly ACS-2 Investigators

This article originally appeared in the February issue of The American Journal of Medicine.

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