Abstract
Aim. To determine the difference in hospi-tal outcomes between percutaneous coro-nary intervention (PCI) and conservative treatment of elderly female patients hos-pitalized for acute coronary syndrome (ACS).Material and Methods. This controlled study included 123 female patients admit-ted to the Clinic for heart and cardiovas-cular diseases University Hospital of Split with a diagnosis of ACS and multiple car-diovascular risk factors. We recorded their habits, history, demographics, presenting symptoms, electrocardiograms, ultra-sound results, laboratory tests, diagnostic tests and treatment. We compared these data between the two groups, i.e., those treated with conservative therapy and those treated with PCI.Results. There were fewer arrhythmias (P<0.001) and episodes of heart failure (P<0.001) during hospitalization in the PCI group than in the conservative ther-apy group. There was no significant differ-ence in complications between the groups (P=0.887).Conclusion. Elderly female patients with ACS treated with PCI had less arrhythmias and heart failure during hospitalization than those treated with conservative ther-apy and there was no difference in com-plications. These results suggest that even high risk patients have better outcomes af-ter treatment with PCI, and therefore PCI is suggested as first-line treatment in these patients, regardless of risk factors.
Highlights
Cardiovascular diseases and especially acute coronary syndrome (ACS) are the leading cause of death in industrialized countries with an incidence of 3 per 1000 inhabitants, and by 2020, are very likely to be so in developing countries as well. [1] Distinguishing patients with ACS among those that present with suspected cardiac pain is a diagnostic challenge, especially in individuals without clear symptoms or electrocardiographic features
Female patients with ACS treated with percutaneous coronary intervention (PCI) had less arrhythmias and heart failure during hospitalization than those treated with conservative therapy and there was no difference in complications
(3) Previous studies have shown that women and elderly with ACS are less likely to undergo diagnostic and therapeutic procedures than men. [4,5,6,7,8,9,10] Underestimation of risk by the treating physician and atypical presentation could be behind these findings, as well as the presumed increased risks of invasive treatment in women. [11,12] The main reason why physicians choose conservative therapy over percutaneous coronary intervention (PCI) in the elderly is because they are concerned about the complications of an invasive approach in these patients
Summary
Cardiovascular diseases and especially acute coronary syndrome (ACS) are the leading cause of death in industrialized countries with an incidence of 3 per 1000 inhabitants, and by 2020, are very likely to be so in developing countries as well. [1] Distinguishing patients with ACS among those that present with suspected cardiac pain is a diagnostic challenge, especially in individuals without clear symptoms or electrocardiographic features. [2] With diagnostic advances and treatment of ACS, mortality in men has been reduced over the past decade; mortality in women has been increasing since 1984. [3] Previous studies have shown that women and elderly with ACS are less likely to undergo diagnostic and therapeutic procedures than men. [11,12] The main reason why physicians choose conservative therapy over percutaneous coronary intervention (PCI) in the elderly is because they are concerned about the complications of an invasive approach in these patients. Because elderly female patients with ACS have the least chance of receiving invasive treatment, we wanted to determine whether there is a difference in hospital outcomes between conservative and invasive therapy in these patients
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