Clinical Impact of Valvular Heart Disease in Elderly Patients Admitted for Acute Coronary Syndrome: Insights From the Elderly-ACS 2 Study: Canadian Journal of Cardiology

G. Crimi, C. Montalto, L.A. Ferri, L. Piatti, I. Bossi, N. Morici, A. Mandurino-Mirizzi, D. Grosseto, G. Tortorella, S. Savonitto, S. De Servi, Elderly-ACS 2 Investigators

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Background: Elderly patients are under-represented in clinical trials and registries, and a gap of evidence exists for clinical decision making in the setting of acute coronary syndromes (ACS). We aimed to assess the prevalence and independent prognostic impact of valvular heart disease (VHD) diagnosed during the index hospitalization on clinical outcomes among elderly patients with ACS. Included VHDs were moderate-to-severe mitral regurgitation (MR), moderate-to-severe aortic stenosis (AS), or both combined. Methods: We explored the Elderly-ACS 2 dataset, which includes patients older than 74 years of age diagnosed with ACS and managed invasively. The primary endpoint was a composite of all-cause death, myocardial infarction, disabling stroke, and rehospitalization for heart failure at 1 year; the secondary endpoint was death for cardiovascular causes. Patients were stratified into 4 groups: no VHD, moderate-to-severe MR, moderate-to-severe AS, and both moderate-to-severe MR and AS. Results: Of the 1443 subjects enrolled, 190 (13.2%) had moderate-to-severe MR, 26 (1.8%) had moderate-to-severe AS, and 13 (0.9%) had both moderate-to-severe MR and AS. When compared with those with no VHD, patients with moderate-to-severe MR had hazard ratios (HRs) for the primary endpoint of 2.04 (95% confidence interval [CI], 1.36-3.07], those with moderate-to-severe AS had HRs of 3.10 (95% CI, 1.39-6.93), and those with both moderate-to-severe MR and AS had HRs of 4.00 (95% CI, 1.65-9.73] (all P < 0.01). Patients with moderate-to-severe MR also had increased risks of cardiovascular death (HR 3.17; 95% CI, 1.57-6.42; P < 0.01), whereas in those with moderate-to-severe AS or both moderate-to-severe MR and AS, a nonsignificant increased risk was observed. Conclusions: In a contemporary cohort of elderly patients admitted for ACS, VHD was found in 1 of 5 subjects and had an independent, consistent impact on prognosis. © 2019 Canadian Cardiovascular Society
Original languageEnglish
Pages (from-to)1104-1111
Number of pages8
JournalCan. J. Cardiol.
Issue number7
Publication statusPublished - 2020


  • acetylsalicylic acid
  • antiarrhythmic agent
  • antidiabetic agent
  • beta adrenergic receptor blocking agent
  • calcium channel blocking agent
  • clopidogrel
  • diuretic agent
  • hydroxymethylglutaryl coenzyme A reductase inhibitor
  • prasugrel
  • troponin
  • acute coronary syndrome
  • aged
  • aortic stenosis
  • Article
  • cardiovascular risk
  • cause of death
  • clinical assessment
  • clinical outcome
  • comparative study
  • controlled study
  • female
  • heart failure
  • heart infarction
  • hospital admission
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  • hospitalization
  • human
  • loading drug dose
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  • male
  • managed care
  • mitral valve regurgitation
  • percutaneous coronary intervention
  • prevalence
  • prognosis
  • randomized controlled trial
  • risk assessment
  • risk factor
  • valvular heart disease


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