Increased use of guideline-recommended therapies, including PCI, over a 12-year period was associated with a decrease in in-hospital mortality from 11.6% to 10.0% (P=0.020) in ACS patients ≥70 years.
Cohort (n=13,662)
Yes
Does the increasing use of guideline-recommended therapies improve in-hospital outcomes in elderly patients with acute coronary syndrome?
The increasing use of guideline-recommended therapies, including PCI, over a 12-year period was associated with improved in-hospital outcomes in elderly ACS patients, despite these patients becoming older and having more comorbidities over time.
Absolute Event Rate: 10% vs 11.6%
p-value: p=0.020
AIMS: To determine whether treatment and outcomes of older acute coronary syndrome (ACS) patients changed over time. METHODS AND RESULTS: We analysed the use of guideline-recommended therapies and in-hospital outcomes of 13 662 ACS patients ≥70 years enrolled in the prospective Acute Myocardial Infarction in Switzerland (AMIS) cohort between 2001 and 2012 according to 4-year periods (2001-2004, 2005-2008, and 2009-2012). Between first and last 4-year period, percutaneous coronary intervention (PCI) use increased from 43.8 to 69.6% of older ACS patients ( ITALIC! P < 0.001). Use of guideline-recommended drugs as well increased. At the same time, in-hospital mortality of the overall population decreased from 11.6% in the first to 10.0% in the last 4-year period ( ITALIC! P = 0.020), and in-hospital major adverse cardiac and cerebrovascular events from 14.4 to 11.3% ( ITALIC! P < 0.001). Percutaneous coronary intervention was used in increasingly older and co-morbid patients over time (mean age of patients treated with PCI 76.2 years in 2001-2004 and 78.1 years in 2009-2012, ITALIC! P < 0.001; Charlson score ≥2 was found for 27.6% of patients treated with PCI in 2001-2004 and for 32.1% in 2009-2012, ITALIC! P = 0.003). Percutaneous coronary intervention use was associated with similar odds ratios (ORs) of in-hospital mortality over time (adjusted OR 0.29, 95% confidence interval, CI, 0.22-0.40, in 2001-2004; and, adjusted OR 0.26, 95% CI 0.20-0.35, in 2009-2012). CONCLUSION: Use of guideline-recommended therapies for ACS increased and in-hospital outcomes improved over the observed 12-year period. Though PCI was used in increasingly older and co-morbid patients, PCI use was associated with similar ORs of in-hospital mortality over time. This study suggests that increasing use of guideline-recommended therapies was appropriate. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01305785.
Schoenenberger et al. (Tue,) conducted a cohort in acute coronary syndrome (n=13,662). Guideline-recommended therapies and PCI vs. Earlier time period (2001-2004) was evaluated on In-hospital mortality (p=0.020). Increased use of guideline-recommended therapies, including PCI, over a 12-year period was associated with a decrease in in-hospital mortality from 11.6% to 10.0% (P=0.020) in ACS patients ≥70 years.