Key result
Advancing age (>70 years) in patients with acute coronary syndrome was an independent predictor of in-hospital mortality (OR 4.71; 95% CI 3.11-7.14) compared to younger patients.
Why the study?
Does advancing age worsen clinical outcomes in patients presenting with acute coronary syndromes?
Cohort (n=7,930)
Yes
Does advancing age worsen clinical outcomes in patients presenting with acute coronary syndromes?
Effect estimate: OR 4.71 (95% CI 3.11-7.14)
Advancing age in ACS patients is associated with under-treatment with evidence-based therapies and significantly worse clinical outcomes, including higher in-hospital mortality.
Supports age-stratified risk assessment in ACS; leaves open whether targeted strategies improve elderly outcomes.
CONTEXT: Elderly patients have more cardiovascular risk factors and a greater burden of ischemic disease than younger patients. AIMS: To examine the impact of age on clinical presentation and outcomes in patients presenting with acute coronary syndrome (ACS). METHODS AND MATERIAL: Collected data from the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2), which is a prospective multicenter study from six adjacent Arab Middle Eastern Gulf countries. Patients were divided into 3 groups according to their age: ≤50 years, 51-70 years and >70 years and their clinical characteristics and outcomes were analyzed. Mortality was assessed at one and 12 months. STATISTICAL ANALYSIS USED: One-way ANOVA test for continuous variables, Pearson chi-square (X (2)) test for categorical variables and multivariate logistic regression analysis for predictors were performed. RESULTS: Among 7930 consecutive ACS patients; 2755 (35%) were ≤50 years, 4110 (52%) were 51-70 years and 1065 (13%) >70 years old. The proportion of women increased with increasing age (13% among patients ≤50 years to 31% among patients > 70 years). The risk factor pattern varied with age; younger patients were more often obese, smokers and had a positive family history of CAD, whereas older patients more likely to have diabetes mellitus, hypertension, and dyslipidemia. Advancing age was associated with under-treatment evidence-based therapies. Multivariate logistic regression analysis after adjusting for relevant covariates showed that old age was independent predictors for re-ischemia (OR 1.29; 95% CI 1.03-1.60), heart failure (OR 2.8; 95% CI 2.17-3.52) and major bleeding (OR 4.02; 95% CI 1.37-11.77) and in-hospital mortality (age 51-70: OR 2.67; 95% CI 1.86-3.85, and age >70: OR 4.71; 95% CI 3.11-7.14). CONCLUSION: Despite being higher risk group, elderly are less likely to receive evidence-based therapies and had worse outcomes. Guidelines adherence is highly recommended in elderly.
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Ahmed et al. (2013) conducted a cohort in Acute coronary syndrome (ACS) (n=7,930). Advancing age (>70 years) vs. Younger age (≤50 years) was evaluated on In-hospital mortality (OR 4.71, 95% CI 3.11-7.14). Advancing age (>70 years) in patients with acute coronary syndrome was an independent predictor of in-hospital mortality (OR 4.71; 95% CI 3.11-7.14) compared to younger patients.
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