Acute Coronary Syndromes in the Elderly: Multicentric Study about 76 Cases in 3 Cardiology Departments in Dakar

Background: Acute coronary syndromes (ACS) in the elderly are often a problem in their diagnosis and treatment, explaining a high mortality. Our study aimed to evaluate diagnostic, therapeutic and evolutive aspects in 3 cardiology departments of Dakar. Patients and Methods: We conducted a multicentric, retrospective and descriptive study during 2 years from January 1, 2017 to December 31, 2018. All patients older than 75 years admitted for acute coronary syndromes were included. The diagnosis was based on clinical signs with typical electrocardiographic changes and troponin assays. Results: Seventy and six patients (76) were enrolled. The prevalence of ACS in the elderly was 2.5% of all hospitalized patients and 21.8% of all ACS. The average age was 78.76 years. The sex ratio male/female was 1.71. The cardiovascular risk factors were essentially physical inactivity (97%) and hypertension (6.84%). Angina pain was the master symptom, but the pain was atypical in the most cases (52.63%). The second sign was dyspnea (46.05%). The average admission time for patients with STEMI (ST-segment elevation myocardial infarction) was 27 hours. Among these patients, 67% had a STEMI, 24% had NSTEMI (non-ST segment elevation myocardial infarction) and 9% had an unstable angina. Four patients had a thrombolysis with an average time of 5.75 hours. The thrombolysis was not successful for all patients. Eighteen (18) patients had a percutaneous coronary intervention (PCI), but only two had a primary PCI. DES (drug-eluting-stents) were the most used stents (55.5%). Eighty and nine (89%) of PCI were successful. Complications were essentially hemodynamic and rhythmic (26.6%). In-hospital mortality was 14.47%; n = 11. Conclusion: Our study revealed a delay in diagnosis and management of ACS in the elderly. Reperfusion therapy was less practiced in our context and the prognosis was poorer with a high mortality.