Are there specific prognostic factors for acute coronary syndrome in patients over 80 years of age?

Purpose: In elderly patients, the prognosis of acute coronary syndrome is bleak and the impact of geriatric factors is as yet unknown. The purpose of this work was to identify factors predictive of poor outcome at Month 6 in a population of elderly subjects admitted into hospital with acute coronary syndrome.

Materials And Methods: One hundred and thirty-two patients over 80 years of age were compared with 127 patients under 80, all admitted into a cardiology intensive care unit with acute coronary syndrome between May 2006 and January 2007, vis-à-vis outcome, mortality and cardiovascular events, both during the hospital stay and six months later.

Results: Coronary angiography was performed in fewer of the over-80 group (85.6% versus 97.7%, p<0.001) but revascularisation rates were comparable in both groups (75.6% versus 78.9%, p=0.58). During the hospital stay, the incidence of complications was higher (68.8% versus 38.1%, p<0.0001) in the older patients as was mortality (18.2% versus 3.2%, p=0.0001). At Month 6, all-cause mortality was higher in the octogenarians (28.0% versus 10.6%, p<0.001). The independent variables associated with Month 6 all-cause mortality in the over-80 group were: systolic blood pressure of less than 100mmHg, an admission heart rate of over 100bpm, a history of cardiovascular disease, acute coronary syndrome with ST segment elevation in the anterior territory, and the absence of chest pain.

Conclusion: In elderly patients admitted into hospital with acute coronary syndrome, geriatric parameters do not seem to affect prognosis which is dominated by cardiac variables.