Abstract 20586: Predictors of Long-Term Survival of Acute Coronary Syndrome Patients Over 90 Years of Age Discharged Alive From a Tertiary Care Center
Introduction: Predictors of long-term mortality of patients over the age of 90 years treated for an acute coronary syndrome (ACS) at a tertiary medical center and discharged alive remain poorly defined.
Hypothesis: We hypothesized that patients over the age of 90 years presenting with an ACS at a tertiary medical center, treated with percutaneous coronary intervention (PCI) and discharged alive have an improved survival compared to those treated conservatively.
Methods: All patients admitted to a tertiary medical center between 2008 and 2012 with ACS and are over the age of 90 were included in this study. Patients were divided into 2 cohorts based on mortality post discharge at one-year follow-up (alive vs dead). Demographics, clinical and procedural variables were collected on all patients from medical records. Univariate and Cox Regression analysis were performed to model for predictors of mortality. Variables included in the multivariate analysis were admission systolic blood pressure (SBP), creatinine (cr), PCI vs medical treatment, history of stroke, dementia and diabetes.
Results: 109 patients (13.9% males) were included. ACS symptoms consisted of unstable angina (UA) 23.9%, NSTEMI 65.4%, STEMI 11%. Coronary intervention was performed in 43.5%. Mean syntax score was 23.2 ±14.5. In-hospital death occurred in 9 patients (8 for non-cardiac and 1 for cardiac reasons). Outpatient follow up data was available on 90% of patients (n=90). Out of hospital death was 41.1% (n=37). Univariate analysis showed no difference in mean age (93.5 ± 2.7), history of CAD, renal insufficiency, HT, heart failure, tobacco use, EF, DM, acuity on presentation or peak CK enzyme level. Index SBP was lower in the cohort that died (121.6 mmHg vs 134.3 mmHg, p=0.005). There was also significantly more PCI in the alive group vs those who died (56.6% vs 43.4%, p=0.051). Cox Regression analysis showed that PCI (HR 2.2, p=0.036) and a higher SBP (HR 0.979, p=0.014) were independent predictor of survival at one year follow up in this patient cohort.
Conclusions: PCI and a higher blood pressure on admission appear to be an independent predictor of long-term survival in patients over the age of 90 admitted with an acute coronary syndrome and discharged alive from a tertiary medical center.
Author Disclosures: N.W. Shammas: Research Grant; Significant; Covidien, Bayer. Speakers Bureau; Significant; Covidien, Bayer, Gilead, Medicine Co. Honoraria; Significant; Covidien, Bayer, Gilead, Medicine Co. Consultant/Advisory Board; Significant; Bayer, Gilead, Medicine Co. G.A. Shammas: None. M. Jerin: None. C. Shanks: None. A. Dvorak: None. P. Serrano: None. C. Harb: None. C.M. Voelliger: None. C. Koepke: None.
- © 2014 by American Heart Association, Inc.