TEMPORAL TRENDS IN THE MANAGEMENT AND OUTCOMES OF THE ELDERLY NON-ST ELEVATION MYOCARDIAL INFARCTION POPULATION IN NOVA SCOTIA

Abstract

s S7 INTRODUCTION: The elderly represent an increasing proportion of patients with acute coronary syndromes (ACS) that are at high risk of mortality and recurrent admissions. According to Statistics Canada, Nova Scotia’s demographic structure comprises the largest proportion of elderly in Canada with an extensive burden of coronary disease such that over one third of ACS occur in patients >75 years. The purpose of this study is to evaluate temporal trends in the management and outcomes of elderly patients in Nova Scotia with non-ST elevation myocardial infarction (NSTEMI), the commonest form of ACS. METHODS: Data were obtained from the Cardiovascular Health Nova Scotia database for all patients admitted with NSTEMI between January 1, 1999 and December 31, 2011. Patients 75 years were defined as elderly and compared to those <75 for study endpoints including discharge medications, cardiac catheterization and revascularization rates, readmission for ACS and mortality. Temporal changes were assessed by comparing the time period 1999-2005 (P1) against 2006-2011 (P2). RESULTS: A total of 15,693 patients were included of which 6505 (41.5%) were 75 years. The elderly cohort had higher rates of hypertension, COPD, renal failure, previous ACS and stroke. The use of ASA, clopidogrel, beta-blockers and statins increased over time but were used less frequently in the elderly. Cardiac catheterization rates increased substantially over time but were lower in the elderly during both P1 (20.5% vs. 55%, p<0.001) and P2 (33.2% vs. 82%, p<0.001). Likewise, an increase in percutaneous coronary intervention (PCI) was noted over time although fewer elderly underwent PCI during both P1 (7.5% vs. 24.6, p<0.001) and P2 (14.8% vs. 43.2%, p<0.001). There was a general temporal decline in overall 6-month and 1year readmission rates for CHF and ACS, including elderly 1year CHF readmissions more frequent during P1 (18.9% vs. 6.7%, p<0.001) and P2 (16.4% vs. 5.6%, p<0.001). In hospital mortality was higher in the elderly during P1 (21.5% vs. 5.5%, p<0.001) and P2 (19% vs. 4.8%, p<0.001). One year mortality was also persistently higher in the elderly during P1 (39.1% vs. 11%, p<0.001) and P2 (37.6% vs. 9%, p<0.001). CONCLUSION: Despite temporal advances in the use of evidence-based medical therapy and revascularization for patients with NSTEMI in Nova Scotia, the elderly are less likely to receive these treatments and their mortality remains very high. 013 IN-HOSPITAL AND LONG-TERM ISCHEMIC AND BLEEDING EVENTS IN PATIENTS WITH MYOCARDIAL INFARCTION UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: FINAL RESULTS FROM THE CANADIAN OBSERVATIONAL ANTIPLATELET STUDY (COAPT) J Dery, HN Fisher, X Zhang, YE Zhu, RC Welsh, S Lavi, A Quraishi, EA Cohen, T Huynh, WJ Cantor, MR Le May, MJ Eisenberg, BF Rose, CB Overgaard, SR Mehta, SG Goodman