Factors associated with major adverse cardiac events in very elderly patients with acute coronary syndrome

Abstract

Prognosis of acute coronary syndrome (ACS) in very elderly patients is bleak. Also older people tend to receive less invasive treatment than younger patients. The aim of our study was to analyze the factors associated with major adverse cardiac events (MACE) on the mid-term outcome of elderly patients admitted with ACS. We retrospectively studied 158 patients 75 years or older admitted for ACS between January 2019 to December 2019. This population was more likely to be male (62% versus (vs.) 38%) with mean age 79,72 ± 4,46 years. The majority of patients had NSTEMI (67% NSTEMI, 33% STEMI). Thirty patients (19%) were managed medically and 128 patients (81%) underwent coronary angiography. Coronary angiograms showed complex coronary lesions with a high incidence of multivessel disease. Percutaneous angioplasty was performed in 88 patients (55.7%). Only 42% of patients had received complete revascularization. Four patients (2.5%) underwent surgical revascularization. At 12-month clinical follow-up, MACE were observed in 17.5%, with no differences between medically treated patients and revascularized patients (14,5% vs. 20%, P = 0,371). The factors associated with MACE were: STEMI compared to NSTEMI (26% vs. 13.5%, P-value 0.055), age ≥ 80 years (23.4% vs. 11.7%, P-value 0.05), obesity (50% vs. 15.3%, P-value 0.005), tachycardia on admission (39.1% vs. 13.7%, P-value 0.003), heart failure (29% vs. 14.6% P-value 0.06), a GRACE score ≥ 140 (35.7% vs. 23.7% vs. 0%, P-value 0.054), stents diameter < 3 mm (61.5% vs. 12.5%, P-value < 0.001) and no reflow (75% vs. 17.3%, P-value 0.005) The prognosis of ACS in the elderly is grim and medical and interventional therapeutic means remain underutilized in this population. A case-by-case assessment integrating the patient's wishes, his comorbidity and his degree of autonomy is necessary in order to assess the benefit/risk ratio of the therapeutic strategy.