Abstract
Background: Elderly patients with non‐ST‐elevation acute coronary syndromes (NSTE‐ACS) may receive benefit from an early invasive strategy. However, aged patients often suffer from comorbidities that may contraindicate an invasive approach and affect prognosis adversely. The impact of comorbidities on an invasive approach to NSTE‐ACS in the elderly has not been fully investigated.
Hypothesis: This study sought to examine the outcome of an unselected population of patients with NSTE‐ACS stratified according to age and treatment approach.
Methods: The feasibility and efficacy of an invasive strategy for NSTE‐ACS and the 6‐month outcome were assessed in 253 unselected consecutive patients ≥ 70 years (elderly) and compared with those of 235 unselected consecutive patients < 70 years.
Results: Angiography was not performed in 69 patients (86% ≥ 70 years) because of contraindications. In the whole population, the 6‐month event rate was significantly higher in elderly compared with younger patients (22 vs. 14%; odds ratio 1.8, 95% confidence interval 1.1‐2.9; p<0.02). This difference was driven by the high event rate observed in the elderly with contraindications to angiography (47 vs. 16% in the elderly treated invasively; p < 0.002). On the other hand, no significant difference was observed in the 6‐month event rate between elderly and younger patients undergoing an invasive approach (16 vs. 13%; p=0.36). Contraindications to angiography—namely, creatinine ≥ 1.5 mg/dl and elevated troponin I at admission—were the only independent predictors of 6‐month outcome.
Conclusions: The invasive approach was feasible in 77% of patients ≥ 70 years. Those with contraindications to angiography showed a poor mid‐term prognosis. The early invasive strategy was associated with more favorable outcomes regardless of age.
Keywords: acute coronary syndromes, elderly, early invasive strategy
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