Outcomes of Very Elderly Patients with ST-Elevation or Non-ST-Elevation Acute Coronary Syndrome: Observational Study

Abstract

Acute coronary syndromes (ACS) have been classified according to the finding of ST-segment elevation on the presenting electrocardiogram, with different treatment strategies and practice guidelines. However, a comparative description of the clinical characteristics and outcomes of acute coronary syndrome in elderly patients has not been published so far. To compare the baseline characteristics and outcomes of STEMI and NSTEMI patients. Retrospective, observational study of patients hospitalized for ACS between January 2018 and December 2019 in the cardiology department of the university hospital of Sfax. The main outcome measure was the incidence of major adverse cardiovascular events (MACE) including cardiovascular death, reinfarction, and stroke. Of 158 ACS patients aged ≥ 75 years (median age 79.72 years, interquartile range 75-97), 33% were classified as ST-elevation myocardial infarction (STEMI), and 67% had non-ST-elevation myocardial infarction (NSTEMI). As compared with those with NSTEMI, STEMI patients had more favorable baseline risk factors with a lower Charlson comorbidity index (3.48 ± 0.18 versus (vs.) 3,84 ± 0.96, P = 0.031), less kidney failure (19.2% vs. 44%, P = 0.005), less prior coronary events (15.7% vs. 44%, P = 0.006) but more severe coronary disease (double vessel disease and triple vessel disease were respectively (45.7% vs. 22%, P = 0.005) and (37% vs. 15.9%, P = 0.007). At a median follow-up of 12 months, MACE were more frequents in STEMI group (26% vs. 13.5%, P = 0.05). Despite more favorable baseline characteristics, elderly STEMI patients have a higher risk of major cardiovascular events compared with NSTEMI patients.