Correlation between comprehensive evaluation of coronary artery lesion severity and long-term clinical outcomes in Chinese octogenarians with acute coronary syndrome.

Background: There is little known about long-term outcome data regarding acute coronary syndrome (ACS) in Chinese octogenarians (> 80 years old). Long-term outcomes of octogenarians with ACS may be associated with increased complicated coronary artery lesion severity.

Methods: We classified 536 consecutive octogenarians with ACS into four groups based on Gensini score. Survival and major adverse cardiac event (MACE) rates were calculated using the Kaplan-Meier method. Multivariate Cox regression was used to identify mortality predictors. The follow-up period was 27 (IQR15-36) months.

Results: The overall long-term mortality rate was 9.1% and increased from 3.0% in group 1 to 16.7% in group 4. Increasing coronary artery lesion severity was associated with increased long-term mortality and MACE rates. ROC curve analysis showed that the predictive cut-off value of Gensini score for mortality was 53. Gensini score provided significant reclassification of mortality (net reclassification index 0.195, P<0.01). Age, gender, heart rate, SBP, chronic renal failure, e-GFR, GRACE score, Gensini score, and ACS type were different between surviving and deceased patients. Notably, chronic renal failure (OR=2.55, P=0.036), GRACE score (OR=1.10, P=0.006), and Gensini score(OR=1.11, P=0.003) were the independent predictors of long-term mortality.

Conclusions: Long-term mortality of octogenarians with ACS was associated with increased comprehensive coronary artery lesion severity. Gensini score was an effective parameter for evaluation of long-term mortality.