Impact of Coronary Intervention on In-Hospital Mortality in Octogenarians and Nonagenarians, Compared to Elderly Patients Aged < 80 Years with Acute Coronary Syndromes

Background: Given that the Australian population is aging, with older patients presenting with acute coronary syndrome (ACS), its management over the past 20 years is likely to have changed.Methods: Retrospective observational study from the New South Wales statewide Admission Patient Data Collection database of those aged !65 years hospitalized for ACS between January 2002 and December 2021.Patients were stratified into 3 age groups: 65-79 years, 80-89 years, !90 years).Temporal trends of ACS, coronary angiogram (CA), and percutaneous coronary intervention (PCI) and inhospital mortality were evaluated.Multivariable analysis was used to adjust for baseline profiles and year of admission in mortality analysis.Results: The study cohort comprised 118,608 patients (56.7% aged 65-79 years [n 67,211]; 34.1% aged 80-89 years [n 40,452]; 9.2% aged !90 years [n 10,945]).Those aged 65-79 years, compared to older groups, had proportionally more male patients, with higher rates of ischemic heart disease, diabetes, smoking history, prior PCI and/or surgical bypass revascularization, and obesity.Heart failure, chronic pulmonary and renal disease, and dementia were more common in the older age groups.Proportionally, ST-elevation myocardial infarction decreased over time, whereas non-ST-elevation myocardial infarction rates increased.Although fewer CAs were performed in the older age groups, PCI rates in those who had CA were higher in those aged !80 years.Multivariable analysis showed that inhospital mortality fell 49% in the group admitted in 2017 or later, vs in 2006 or earlier; for the younger, vs the older age groups, mortality fell by 55.4%, 52.5%, and 44.6%, respectively.The group aged !90 years R ESUM E Contexte : Avec le vieillissement de la population australienne, les patients plus g es pr esentant un syndrome coronarien aigu (SCA) et leur prise en charge au cours des vingt dernires ann ees auraient chang e. M ethodologie : tude observationnelle r etrospective partir de la base de donn ees Admission-Patient-Data-Collection de l'tat de Nouvelle-Galles du Sud, portant sur les patients g es de !65 ans hospitalis es pour un SCA entre janvier 2002 et d ecembre 2021.Les patients ont et e cat egoris es en trois groupes d'ge (65-79 ans; 80-89 ans; !90 ans).Les tendances temporelles du SCA, de la coronarographie (CG), de l'intervention coronarienne percutan ee (ICP) et de la mortalit e hospitalire ont et e evalu ees.Une analyse multivari ee a et e utilis ee pour ajuster l'analyse de la mortalit e en fonction des profils cliniques de base et des cohortes d'ann ees d'hospitalisation.R esultats : La cohorte comprenait 118 608 patients (56,7 % g es de 65-79 ans [n67 211]; 34,1 % de 80-89 ans [n40 452]; 9,2 % !90 ans [n10 945]).Le groupe des 65-79 ans, compar e aux groupes plus g es, comptait proportionnellement plus d'hommes avec des taux plus elev es de cardiopathie isch emique, de diabte, d'ant ec edents de tabagisme, d'ICP ant erieure et/ou de revascularisation par pontage chirurgical, et d'ob esit e. L'insuffisance cardiaque, les maladies pulmonaires et r enales chroniques, et la d emence etaient plus fr equentes dans les groupes plus g es.Proportionnellement, les infarctus du myocarde avec el evation du segment ST ont diminu e au fil du temps, tandis que les taux d'infarctus sans el evation du segment ST ont augment e. Bien que les CG aient et e r ealis ees moins fr equemmentThe proportion of the elderly within the population is increasing at a faster rate than that of those who are younger, due to increasing life expectancy and declining fertility rates.Projections indicate that by 2066, older people in Australia will make up 21% to 23% of the population, with 1 in 5 (w2.2 million) of the elderly being aged !85 years. 1