Prognostic Impact of Interventional Approach in Non-ST Segment Elevation Acute Coronary Syndrome in Very Elderly Patients

• Published in: Revista española de cardiología (English ed.) 2011-10, Vol.64 (10), p.853-861
• Main Authors: Villanueva-Benito, Iñaki, Solla-Ruíz, Itziar, Paredes-Galán, Emilio, Díaz-Castro, Óscar, Calvo-Iglesias, Francisco E., Baz-Alonso, Jose A., Íñiguez-Romo, Andrés
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome; Ancianos; Cardiología intervencionista; Coronariografía; Coronary angiography; Coronary artery disease; Enfermedad coronaria; Geriatric medicine; Geriatría; Interventional cardiology; Prognosis; Pronóstico; Supervivencia; Survival; Síndrome coronario agudo; The Elderly
• ISSN: 1885-5857; 1885-5857
• DOI: 10.1016/j.rec.2011.04.019

In moderate or high risk non-ST segment elevation acute coronary syndrome, clinical practice guidelines recommend a coronary angiography with intent to revascularize. However, evidence to support this recommendation in very elderly patients is poor. All patients over 85 years old admitted to our hospital between 2004 and 2009 with a diagnosis of non-ST segment elevation acute coronary syndrome were retrospectively included. Using a propensity score, patients undergoing the interventional approach and those undergoing conservative management were matched and compared for survival and survival without ischemic events. We included 228 consecutive patients with a mean age of 88 years (range: 85 to 101). Those in the interventional approach group (n = 100) were younger, with a higher proportion of males and less comorbidity, less cognitive impairment and lower troponin I levels compared with patients in the conservative management group (n = 128). We matched 63 patients from the interventional approach group and 63 from the conservative management group using propensity score. In the matched patients, the interventional approach group exhibited better survival (log rank 4.24; P = .039) and better survival free of ischemic events (log rank 8.63; P = .003) at the 3-year follow-up. In the whole population, adjusted for propensity score quintiles, the interventional approach group had lower mortality (hazard ratio 0.52; 95% confidence interval: 0.32-0.85) and a better survival free of ischemic events (hazard ratio 0.48; 95% confidence interval: 0.32-0.74). Nearly all the very elderly patients admitted with non-ST segment elevation acute coronary syndrome were of moderate or high risk. In these patients, the interventional approach was associated with overall better survival and better survival free of ischemic events. En el síndrome coronario agudo sin elevación del segmento ST de riesgo intermedio o alto, las guías de actuación clínica recomiendan la realización de coronariografía con intención de revascularizar. Sin embargo, para los pacientes muy ancianos la evidencia que avala esta recomendación es muy escasa. Analizamos retrospectivamente a todos los pacientes con síndrome coronario agudo sin elevación del segmento ST y edad ≥ 85 años ingresados en un único centro entre 2004 y 2009. Mediante propensity score, emparejamos 1:1 a los pacientes con abordaje intervencionista con aquellos en que se decidió manejo conservador. Se comparó la supervivencia y la supervi