Key result
Advanced age in ACS is linked to ~148% higher 30-day mortality and less invasive treatment.
Why the study?
The elderly are underrepresented in ACS clinical trials and there is uncertainty regarding optimal management, especially invasive revascularisation, in this group.
Does invasive treatment improve outcomes compared to non-invasive treatment in elderly patients hospitalized with acute coronary syndrome?
Observational (n=13,545)
Yes
Does invasive treatment improve outcomes compared to non-invasive treatment in elderly patients hospitalized with acute coronary syndrome?
Relative Risk: 2.48 (95% CI 2.04–3.03)
Absolute Event Rate: 13.9% vs 5.6%
p-value: p=<0.001
Elderly patients with ACS in Malaysia are undertreated invasively, despite invasive treatment appearing to yield better outcomes in this demographic.
Excess mortality in elderly ACS may relate to lower invasive treatment rates; leaves open whether invasive strategies improve outcomes.
INTRODUCTION: The elderly are often underrepresented in clinical trials for acute coronary syndrome (ACS), and cardiologists commonly face management dilemmas in the choice of treatment for this group of patients, particularly concerning the use of invasive revascularisation. This study analysed the characteristics of hospitalised elderly patients with ACS, and compared the outcomes of treatments. METHODS: From 29 December 2005 to 26 April 2010, 13,545 patients were admitted for ACS in 16 hospitals across Malaysia. These patients were divided into two groups - elderly (≥ 65 years) and non-elderly (< 65 years). The clinical characteristics, treatment received (invasive or non-invasive) and outcomes (in-hospital and 30-day all-cause mortality) of the two groups were compared. The elderly patients were then grouped according to the type of treatment received, and the outcomes of the two subgroups were compared. RESULTS: Elderly patients had a higher cardiovascular risk burden and a higher incidence of comorbidities. They were less likely to receive urgent revascularisation for acute ST-segment elevation myocardial infarction (elderly: 73.9% vs. non-elderly: 81.4%) and had longer door-to-needle time (elderly: 60 minutes vs. non-elderly: 50 minutes, p = 0.004). The rate of cardiac catheterisation was significantly lower in the elderly group across all ACS strata. Elderly patients had poorer outcomes than non-elderly patients, but those who received invasive treatment appeared to have better outcomes than those who received non-invasive treatment. CONCLUSION: Elderly patients with ACS tend to be undertreated, both invasively and pharmacologically. Invasive treatment seems to yield better outcomes for this group of patients.
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Zuhdi et al. (2015) conducted an observational in Acute coronary syndrome (n=13,545). Elderly age (≥ 65 years) vs. Non-elderly age (< 65 years) was evaluated on 30-day all-cause mortality (RR 2.48, 95% CI 2.04-3.03, p=<0.001). Elderly patients with acute coronary syndrome had a significantly higher adjusted risk of 30-day mortality compared to non-elderly patients (RR 2.48), and were less likely to receive invasive treatments.
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