Therapeutic management and outcome of nonagenarians versus octogenarians admitted to an intensive care unit for acute coronary syndromes

Abstract

The number of very old patients admitted to intensive care units for acute coronary syndromes has increased gradually, but these patients are under-represented in randomized clinical trials. The aim of this study was to analyse mortality of nonagenarians compared with octogenarians admitted to an intensive care unit for acute coronary syndromes, to describe their management and to identify prognostic factors. Patients aged≥80years admitted to an intensive care unit (Croix-Rousse University Hospital, Lyon) with a diagnosis of acute coronary syndrome from 1 January 2013 to 31 December 2016 were included retrospectively. After exclusion of type 2 acute coronary syndromes, the data for 311 octogenarians and 92 nonagenarians were analysed using Kaplan-Meier curves and a multivariable Cox regression model. More than 70% of patients received renin-angiotensin-system blockers, beta-blockers and statins, without significant difference between nonagenarians and octogenarians. Nonagenarians were treated significantly less frequently with ticagrelor than octogenarians (P=0.028). Overall, 97.8% of patients had a coronary angiogram, and 80.4% underwent percutaneous coronary intervention. At 5-year follow-up, the survival rate was 62.8% for nonagenarians compared with 73.1% for octogenarians (P=0.007), but no significant difference was observed for cardiovascular mortality (P=0.17). Global Registry of Acute Coronary Events (GRACE) score and increased age were significantly associated with higher mortality rate, while renin-angiotensin-system blockers, statins and ticagrelor were protective factors. Although overall mortality was higher in patients aged≥90 years compared with those aged<90years with acute coronary syndromes, the overall survival reported here is acceptable. In addition to the effect of age, the difference in prognosis according to age may be explained, in part, by a non-optimal treatment strategy for older patients.