Outcomes of Elderly Patients with ST-Elevation or Non-ST-Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Elderly ACS-2 Investigators

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction: Acute coronary syndromes (ACS) have been classified according to the finding of ST-segment elevation on the presenting electrocardiogram, with different treatment strategies and practice guidelines. However, a comparative description of the clinical characteristics and outcomes of acute coronary syndrome elderly patients undergoing percutaneous coronary intervention during index admission has not been published so far. Methods: Retrospective cohort study of patients enrolled in the Elderly ACS-2 multicenter randomized trial. Main outcome measures were crude cumulative incidence and cause-specific hazard ratio (cHR) of cardiovascular death, noncardiovascular death, reinfarction, and stroke. Results: Of 1443 ACS patients aged >75 years (median age 80 years, interquartile range 77-84), 41% were classified as ST-elevation myocardial infarction (STEMI), and 59% had non-ST-elevation ACS (NSTEACS) (48% NSTEMI and 11% unstable angina). As compared with those with NSTEACS, STEMI patients had more favorable baseline risk factors, fewer prior cardiovascular events, and less severe coronary disease, but lower ejection fraction (45% vs 50%, P <.001). At a median follow-up of 12 months, 51 (8.6%) STEMI patients had died, vs 39 (4.6%) NSTEACS patients. After adjusting for sex, age, and previous myocardial infarction, the hazard among the STEMI group was significantly higher for cardiovascular death (cHR 1.85; 95% confidence interval [CI], 1.02-3.36), noncardiovascular death (cHR 2.10; 95% CI, 1.01-4.38), and stroke (cHR 4.8; 95% CI, 1.7-13.7). Conclusions: Despite more favorable baseline characteristics, elderly STEMI patients have worse survival and a higher risk of stroke compared with NSTEACS patients after percutaneous coronary intervention.

Original languageEnglish
JournalAmerican Journal of Medicine
DOIs
Publication statusAccepted/In press - Jan 1 2018

Fingerprint

Percutaneous Coronary Intervention
Acute Coronary Syndrome
Stroke
Confidence Intervals
Cause of Death
Unstable Angina
Practice Guidelines
Multicenter Studies
Coronary Disease
Electrocardiography
Cohort Studies
Retrospective Studies
Myocardial Infarction
Outcome Assessment (Health Care)
ST Elevation Myocardial Infarction
Survival
Incidence

Keywords

  • Acute coronary syndrome
  • Elderly
  • Myocardial infarction

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{ff2867d10f11414aa989c2ff852cbff0,
title = "Outcomes of Elderly Patients with ST-Elevation or Non-ST-Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention",
abstract = "Introduction: Acute coronary syndromes (ACS) have been classified according to the finding of ST-segment elevation on the presenting electrocardiogram, with different treatment strategies and practice guidelines. However, a comparative description of the clinical characteristics and outcomes of acute coronary syndrome elderly patients undergoing percutaneous coronary intervention during index admission has not been published so far. Methods: Retrospective cohort study of patients enrolled in the Elderly ACS-2 multicenter randomized trial. Main outcome measures were crude cumulative incidence and cause-specific hazard ratio (cHR) of cardiovascular death, noncardiovascular death, reinfarction, and stroke. Results: Of 1443 ACS patients aged >75 years (median age 80 years, interquartile range 77-84), 41{\%} were classified as ST-elevation myocardial infarction (STEMI), and 59{\%} had non-ST-elevation ACS (NSTEACS) (48{\%} NSTEMI and 11{\%} unstable angina). As compared with those with NSTEACS, STEMI patients had more favorable baseline risk factors, fewer prior cardiovascular events, and less severe coronary disease, but lower ejection fraction (45{\%} vs 50{\%}, P <.001). At a median follow-up of 12 months, 51 (8.6{\%}) STEMI patients had died, vs 39 (4.6{\%}) NSTEACS patients. After adjusting for sex, age, and previous myocardial infarction, the hazard among the STEMI group was significantly higher for cardiovascular death (cHR 1.85; 95{\%} confidence interval [CI], 1.02-3.36), noncardiovascular death (cHR 2.10; 95{\%} CI, 1.01-4.38), and stroke (cHR 4.8; 95{\%} CI, 1.7-13.7). Conclusions: Despite more favorable baseline characteristics, elderly STEMI patients have worse survival and a higher risk of stroke compared with NSTEACS patients after percutaneous coronary intervention.",
keywords = "Acute coronary syndrome, Elderly, Myocardial infarction",
author = "{Elderly ACS-2 Investigators} and Nuccia Morici and Stefano Savonitto and Ferri, {Luca A.} and Daniele Grosseto and Irene Bossi and Paolo Sganzerla and Giovanni Tortorella and Michele Cacucci and Maurizio Ferrario and Gabriele Crimi and Ernesto Murena and Stefano Tondi and Anna Toso and Nicola Gandolfo and Amelia Ravera and Elena Corrada and Matteo Mariani and {Di Ascenzo}, Leonardo and Petronio, {A. Sonia} and Claudio Cavallini and Giancarlo Vitrella and Roberto Antonicelli and Federico Piscione and Renata Rogacka and Laura Antolini and Gianfranco Alicandro and {La Vecchia}, Carlo and Luigi Piatti and {De Servi}, Stefano",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.amjmed.2018.10.027",
language = "English",
journal = "American Journal of Medicine",
issn = "0002-9343",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Outcomes of Elderly Patients with ST-Elevation or Non-ST-Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

AU - Elderly ACS-2 Investigators

AU - Morici, Nuccia

AU - Savonitto, Stefano

AU - Ferri, Luca A.

AU - Grosseto, Daniele

AU - Bossi, Irene

AU - Sganzerla, Paolo

AU - Tortorella, Giovanni

AU - Cacucci, Michele

AU - Ferrario, Maurizio

AU - Crimi, Gabriele

AU - Murena, Ernesto

AU - Tondi, Stefano

AU - Toso, Anna

AU - Gandolfo, Nicola

AU - Ravera, Amelia

AU - Corrada, Elena

AU - Mariani, Matteo

AU - Di Ascenzo, Leonardo

AU - Petronio, A. Sonia

AU - Cavallini, Claudio

AU - Vitrella, Giancarlo

AU - Antonicelli, Roberto

AU - Piscione, Federico

AU - Rogacka, Renata

AU - Antolini, Laura

AU - Alicandro, Gianfranco

AU - La Vecchia, Carlo

AU - Piatti, Luigi

AU - De Servi, Stefano

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Introduction: Acute coronary syndromes (ACS) have been classified according to the finding of ST-segment elevation on the presenting electrocardiogram, with different treatment strategies and practice guidelines. However, a comparative description of the clinical characteristics and outcomes of acute coronary syndrome elderly patients undergoing percutaneous coronary intervention during index admission has not been published so far. Methods: Retrospective cohort study of patients enrolled in the Elderly ACS-2 multicenter randomized trial. Main outcome measures were crude cumulative incidence and cause-specific hazard ratio (cHR) of cardiovascular death, noncardiovascular death, reinfarction, and stroke. Results: Of 1443 ACS patients aged >75 years (median age 80 years, interquartile range 77-84), 41% were classified as ST-elevation myocardial infarction (STEMI), and 59% had non-ST-elevation ACS (NSTEACS) (48% NSTEMI and 11% unstable angina). As compared with those with NSTEACS, STEMI patients had more favorable baseline risk factors, fewer prior cardiovascular events, and less severe coronary disease, but lower ejection fraction (45% vs 50%, P <.001). At a median follow-up of 12 months, 51 (8.6%) STEMI patients had died, vs 39 (4.6%) NSTEACS patients. After adjusting for sex, age, and previous myocardial infarction, the hazard among the STEMI group was significantly higher for cardiovascular death (cHR 1.85; 95% confidence interval [CI], 1.02-3.36), noncardiovascular death (cHR 2.10; 95% CI, 1.01-4.38), and stroke (cHR 4.8; 95% CI, 1.7-13.7). Conclusions: Despite more favorable baseline characteristics, elderly STEMI patients have worse survival and a higher risk of stroke compared with NSTEACS patients after percutaneous coronary intervention.

AB - Introduction: Acute coronary syndromes (ACS) have been classified according to the finding of ST-segment elevation on the presenting electrocardiogram, with different treatment strategies and practice guidelines. However, a comparative description of the clinical characteristics and outcomes of acute coronary syndrome elderly patients undergoing percutaneous coronary intervention during index admission has not been published so far. Methods: Retrospective cohort study of patients enrolled in the Elderly ACS-2 multicenter randomized trial. Main outcome measures were crude cumulative incidence and cause-specific hazard ratio (cHR) of cardiovascular death, noncardiovascular death, reinfarction, and stroke. Results: Of 1443 ACS patients aged >75 years (median age 80 years, interquartile range 77-84), 41% were classified as ST-elevation myocardial infarction (STEMI), and 59% had non-ST-elevation ACS (NSTEACS) (48% NSTEMI and 11% unstable angina). As compared with those with NSTEACS, STEMI patients had more favorable baseline risk factors, fewer prior cardiovascular events, and less severe coronary disease, but lower ejection fraction (45% vs 50%, P <.001). At a median follow-up of 12 months, 51 (8.6%) STEMI patients had died, vs 39 (4.6%) NSTEACS patients. After adjusting for sex, age, and previous myocardial infarction, the hazard among the STEMI group was significantly higher for cardiovascular death (cHR 1.85; 95% confidence interval [CI], 1.02-3.36), noncardiovascular death (cHR 2.10; 95% CI, 1.01-4.38), and stroke (cHR 4.8; 95% CI, 1.7-13.7). Conclusions: Despite more favorable baseline characteristics, elderly STEMI patients have worse survival and a higher risk of stroke compared with NSTEACS patients after percutaneous coronary intervention.

KW - Acute coronary syndrome

KW - Elderly

KW - Myocardial infarction

UR - http://www.scopus.com/inward/record.url?scp=85057593823&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85057593823&partnerID=8YFLogxK

U2 - 10.1016/j.amjmed.2018.10.027

DO - 10.1016/j.amjmed.2018.10.027

M3 - Article

AN - SCOPUS:85057593823

JO - American Journal of Medicine

JF - American Journal of Medicine

SN - 0002-9343

ER -