Abstract 21411: Medium Term Prognosis in Non-st Segment Elevation Acute Coronary Syndromes in the Older Older. Clinical Outcomes Depending on Invasive vs. Conservative Strategies.
Introduction: The benefit of an aggressive strategy using current interventional therapies rather than a conservative approach is not clearly defined in the very elderly patient presenting with coronary syndrome without persistent ST-segment elevation (NSTE-ACS). We aim to establish the impact that interventional management exert on morbidity and mortality compared to non aggressive management.
Methods: Retrospective study of all over 85 year olds admitted to our tertiary hospital between January 1st 2004 and January 1st 2009 with a diagnosis of NSTE-ACS. We carried out propensity score matching of patients undergoing interventional management (IM) and those enduring non invasive medical treatment (MT), comparing new revascularization, survival and rehospitalization due to ACS.
Results: Out of the 228 patients included in our cohort, 177 sustained non-ST elevation myocardial infarction and 51 received a diagnosis of unstable angina. Mean age at the time of hospitalization was 87 years (85 to 101). Those in the intervention management group (n = 100) were younger with a higher proportion of males but presented less number of comorbidities, cognitive impairment and lower troponin I levels compared to the individuals in the MT group (n = 128). We matched 70 individuals from the IM and 70 subjects from the TM group and found no significant baseline differences. During hospitalization, TIMI hemorrhagic complications (IM: 5, MT: 6), renal dysfunction (IM: 5, MT: 3), new myocardial infarction (IM: 3, MT: 1) and mortality rates (IM: 4, MT: 2) were similar in both groups. At three year follow up the interventional management group exhibited lower death, readmission and revascularisation rates (Log Rank 3, 78, p: 0, 05)
Conclusions: Invasive strategy is associated with an overall better medium-term outcome and prognosis in very elderly patients admitted to hospital following NSTE-ACS.
- © 2010 by American Heart Association, Inc.