Abstract 17788: Impact of an Invasive Strategy on In-Hospital Outcomes in Nonagenarians With Acute Coronary Syndrome: Insights From the AMI-OPTIMA Study
Background: Nonagerians constitute a growing proportion of patients with acute coronary syndromes (ACS). Currently, little is known about their characteristics, prognosis and optimal management. We aim to describe the characteristics, management and the impact of an invasive strategy in nonagerians hospitalized for ACS.
Methods and Results: We reviewed the hospital charts of 100 consecutive patients admitted with ACS at 24 Quebec hospitals (Canada) in 2009 and 2012. We defined invasive strategy as coronary angiogram with/without coronary intervention. We used inverse probability weighting to adjust for confounders between the patients who underwent invasive treatment versus those who were treated conservatively.
Results: There were 4,569 patients (2,371 in 2009 and 2,198 in 2012). The age distribution was as followed: 2,395 (52%) <70, 1031 (23%) 70-79, 941 (21%) 80-89 and 202 (4.4%) ≥90 years. Nonagerians had higher in-hospital all-cause mortality compared to patients less than 70 years old (24.0% vs 1.3%, p<0.001). An invasive strategy was associated with reduction in in-hospital mortality in all age groups: 1.1% vs 3.7% in patients <70 years old (p<0.001; number needed to treat (NNT) 38), 2.9% vs 9.0% in septuagenarians (p<0.001; NNT 16), 6.2% vs 15% in octogenarians (p<0.001; NNT 11) and 17% vs 26% in nonagerians (p=0.039; NNT 11). The invasive strategy was associated with marked reductions in both all-cause and cardiovascular mortalities, ranging from 70% to 30% in patients younger than 70 years and nonagerians, respectively (Figure 1). However, compared to the conservative strategy, the invasive strategy was associated with increase in TIMI major bleedings mainly in the nonagerians (9.6% vs 2.0 %, p<0.001; number needed to harm of 13).
Conclusions: Nonagerians with ACS had high rates of in-hospital mortality. An invasive strategy was associated with improved survival, at the expense of increased risks for TIMI major bleeding.
Author Disclosures: E.L. Couture: None. P. Farand: None. M. Nguyen: None. C. Allard: None. J. Afilalo: None. M. Afilalo: None. E. Schampaert: None. M. Eisenberg: None. M. Montigny: None. S. Mansour: None. S. Kouz: None. C. Lauzon: None. J. Tardif: None. T. Huynh: None.
- © 2016 by American Heart Association, Inc.