Epidemiology, management and outcome in acute coronary syndromes of octogenarians: the EURHOBOP study in Portugal

Abstract

Introduction: Advanced age is an important risk factor for acute coronary syndrome (ACS). Our purpose was to evaluate the particularities of ACS in octogenarians in comparison with the younger group. Methods: We studied a sample of 3009 cases of ACS from 10 Portuguese public hospitals, consecutively discharged within each hospital in 2009. The discharge notes and electronic/paper medical files were retrospectively reviewed by trained data extractors according to a standard protocol. We divided patients into two categories (<80 years and ≥ 80 years) and compared clinical data. Results: The very old group comprised 21.4% (n=645) of all ACS patients and 56.3% were women (versus 27.2% in the younger group; p<0.001) with a mean age of 84.7 years. Discharge diagnosis in this group was non-ST-segment elevation myocardial infarction (NSTEMI) in 59.3%, ST segment elevation myocardial infarction (STEMI) in 32.3% and unstable angina in 8.5%. The octogenarians were more likely to have a NSTEMI (59.3% vs 51.2%; p=0.003) than the younger group. Co-morbidities like arterial hypertension and prior atrial fibrillation were more frequent in the older patients than their younger counterparts (71.8% vs 64.8%; 11.6% vs 5.2%, respectively; p=0.001)]. A lower percentage of the old patients underwent coronary angiography (39.7% vs 77.0%; p<0.001), percutaneous coronary intervention (24.2% vs 50.0%; p<0.001) and systolic ventricular function evaluation (34.7% vs 20.7%; p=0.001) than younger patients. The incidence of in-hospital complications, namely: new onset of atrial fibrillation (15.8% vs 7.5%; p<0.001), atrioventricular block (5.1% vs 2.6%; p<0.001), cardiac (28.4% vs 17.1%; p<0.001) or renal failure (18.9% vs 6.4%; p<0.001), mitral regurgitation (12.3% vs 6.6%; p<0.001) and stroke (1,7% vs 0.8%; p=0.041) were higher in the very old group. Octogenarians had a highest in-hospital mortality rate (16.7% vs 5.3%, p<0.001). Conclusion: The very old patients with ACS differed from the younger in the clinical presentation (often NSTEMI), more co-morbidities, less early aggressive treatment and worse in-hospital outcomes. These results suggest that we have to improve that population's treatment, in order to improve their hospital outcome as well as to increase their quality of life.