The management and investigation of elderly patients with acute coronary syndromes without ST elevation: an evidence-based approach? Results of the Prospective Registry of Acute Ischaemic Syndromes in the United Kingdom (PRAIS-UK)

Background: in the elderly, acute coronary syndromes (ACS) without ST elevation are a frequent and important cause of admission. In the UK, practice patterns and outcomes in these patients need to be assessed. Methods: we enrolled 1,046 patients admitted with ACS without ST elevation to 56 UK centres (20 consecutive patients per centre) and followed them for 6 months. We compared baseline characteristics, outcomes and treatments in those aged 80 and over (n = 119, 11%), from 70 to 79 (n = 301, 29%), from 60 to 69 (n = 283, 27%) with those below 60 (n = 343, 33%). Results: the proportions of males were 40, 52, 67 and 70%, respectively (P < 0.001). There were no differences in the proportion of patients with diabetes (17% overall), treated hypertension (38%) or prior myocardial infarction (MI) (48%). The proportions with ST depression or bundle branch block on admission ECG were 40, 39%, and 28, 18% (P < 0.001), respectively. The rates of the composite endpoint of death or new MI at 6 months were 20, 18, 12 and 6% (P < 0.001), respectively. Heparin, beta blockers and statins were used in significantly higher proportions in younger patients compared with older patients. Similarly, older patients had significantly lower rates of angiography and revascularisation compared with younger patients. Conclusion: in this large population-based registry of UK patients admitted to hospital with ACS without ST elevation, those aged over 70 are at substantially higher risk of adverse events than younger patients. However, they are less likely to receive treatments of proven benefit or to be investigated with a view to revascularisation. A more aggressive approach to these patients may be more appropriate and is likely to result in substantial benefits.