Analysis of hospital mortality in acute coronary syndrome in elderly and long-lived patients

Abstract

Abstract Objective To evaluate the effect of clinical and medical history, laboratory and instrumental indicators, patient management tactics on the level of hospital mortality in patients with ACS in senile patients and long-livers. Materials and methods The study included 1520 senile patients (75–90 years old) and 96 long-livers (90–103 years old) hospitalized with a diagnosis of ACS. Depending on the management tactics, each age group was divided into 2 subgroups - invasive management - balloon angioplasty and stenting of the coronary arteries (n=670 in the group of old age, n=12 in the group of long-livers) and conservative management - patients who refused invasive intervention (n=850 in the group of senile age, n=84 in the group of centenarians). Results Hospital mortality rates in elderly patients were 11%, long-livers were significantly higher - 30%, significantly differing in the subgroups of invasive and conservative treatment in elderly patients (7.5% vs 14.5%; p=0.0368) while in long-livers these differences did not reach statistical significance (15.8% vs 38.7%; p=0.1175). Most patients of both age groups died during the first days of hospitalization - 68.2% and 73.5% of cases for senile age and long-livers, respectively, while the level of pre-mortality was comparable with conservative and invasive approaches to treatment. Clinical-anamnestic, laboratory and instrumental indicators that had a significant impact on the level of hospital mortality in elderly patients, regardless of management tactics, included the presence of clinically manifest multifocal atherosclerosis (p=0.003), class acute cardiac failure III-IV according to Killip (p=0.007), the presence of ST segment elevation (p=0.001), decreased LVEF (S) <42% (p=0.01), the development of acute kidney damage (p=0.006), and an electric storm (p=0.0005). In long-livers, these parameters also, regardless of management tactics, included Killip class acute cardiac failure III-IV (p=0.03), the presence of ST segment elevation (p=0.004), the development of acute kidney damage (p=0.001), and an electric storm (p=0.003), grade 3 atrioventricular block (p=0.02), acute erosive-ulcerative gastropathy with a decrease in hemoglobin level of more than 20 g / l (p=0.04). Conclusions Patients of older age groups are characterized by high rates of daily mortality. The level of hospital mortality in senile patients and long-livers is determined by a number of clinical and medical history, laboratory and instrumental parameters, the significance of which does not depend on patient management tactics. The choice of treatment strategy has a significant effect on hospital mortality in elderly people, while the development of complications of ACS played a large role in thanatogenesis in long-livers. Funding Acknowledgement Type of funding source: None