Treatment of elderly patients with non-ST-elevation myocardial infarction: the nationwide POPular age registry.

Abstract

We describe the current treatment of elderly patients with non-ST-elevation myocardial infarction (NSTEMI) enrolled in anational registry. The POPular AGE registry is aprospective, multicentre study of patients ≥ 75years of age presenting with NSTEMI, performed in the Netherlands. Management was at the discretion of the treating physician. Cardiovascular events consisted of cardiovascular death, myocardial infarction and ischaemic stroke. Bleeding was classified according to the Bleeding Academic Research Consortium (BARC) criteria. Atotal of 646 patients were enrolled between August 2016 and May 2018. Median age was81 (IQR 77-84) years and 58% were male. Overall, 75% underwent coronary angiography, 40% percutaneous coronary intervention, and 11% coronary artery bypass grafting, while 49.8% received pharmacological therapy only. At discharge, dual antiplatelet therapy (aspirin and P2Y12 inhibitor) was prescribed to 56.7%, and 27.4% received oral anticoagulation plus at least one antiplatelet agent. At 1‑year follow-up, cardiovascular death, myocardial infarction or stroke had occurred in 13.6% and major bleeding (BARC3 and5) in 3.9% of patients. The risk of both cardiovascular events and major bleeding was highest during the 1stmonth. However, cardiovascular risk was three times as high as bleeding risk in this elderly population, both after 1month and after 1year. In this national registry of elderly patients with NSTEMI, the majority are treated according to current European Society of Cardiology guidelines. Both the cardiovascular and bleeding risk are highest during the 1stmonth after NSTEMI. However, the cardiovascular risk was three times as high as the bleeding risk.