Abstract 2807: Is Invasive Strategy A Feasible Alternative For Acute Coronary Syndromes In Patients Older Than 80 Years?
Background: Lack of consensus regarding use of an invasive strategy in the very elderly with coronary artery disease has repeatedly been demonstrated. This is in part due to the fear of complications and to the assumption that nothing can be done in most of these cases because of advanced disease. At the same time, the number of these patients is increasing in western societies.
Methods: Data from the Register of Information and Knowledge about Swedish Heart Intensive care Admissions (RIKS-HIA) was analyzed in 54850 patients of age 80 years or older admitted between the years 2000–2005 with an acute coronary syndrome (ACS). To evaluate potential early hazard or benefit from revascularization performed within 14 days 1-year mortality was evaluated both in all patients and in 14-days survivals (n=47865). A multivariable Cox regression analysis was performed including 15 covariates.
Results: Crude 1-year mortality in patients revascularized within 14 days of admission was 16.0% (857/5369) vs. 35.6% (17596/ 49481) in those revascularized later or not at all (p<0.001) comparing patients from the admission day, and when only 14-day survivors were compared 9.4% (345/3664) vs. 25.9% (9407/36260) (p<0.001). In the Cox regression analysis revascularization was associated with reduced 1-year mortality RR 0.52 (95% CI, 0.48–0.56; p<0.001) in all patients and RR 0.43 (95% CI, 0.42–0.51; p<0.001) in 14-day survivors.
Conclusion: Also in patients older than 80 years with ACS revascularization is feasible and with the selection done by physicians associated with improved survival when comparing patients with similar comorbidity and risk factors.