BACKGROUND: The purpose was to assess age-related differences in hospital management and mortality in non-ST-elevation acute coronary syndrome (NSTE ACS) patients treated conservatively, with a focus on the influence of aggressive pharmacological treatment on in-hospital clinical outcome. METHODS: We identified 807 NSTE ACS patients treated conservatively in the 29 hospitals participating in the Krakow Registry of Acute Coronary Syndromes from February to March 2005 and from December 2005 to January 2006. Out of 807 patients' 32.1% were less than 65 years of age, 33% from 65 to 74, 30.5% from 75 to 84, and 5.3% >or= 85. For all patients, pharmacotherapy index based on the use of pharmacological treatment regimen during hospital stay was assessed. Each patient received 1 point for each of the following guideline-recommended drugs used: aspirin, clopidogrel, glycoprotein IIb/IIIa inhibitor, LMWH, beta-blocker, ACE inhibitor/angiotensin II receptor blocker and statin - the range of points being from 0 to 7. RESULTS: Significant age-related differences in baseline characteristics and pharmacotherapy index values were found. In-hospital mortality was higher in elderly patients (2.4% vs. 3.4% vs. 8.9% vs. 14.0%, respectively for age groups, p < 0.0001). Similarly, in non-shock patients and in patients with elevated cardiac markers, age-dependent differences in mortality were observed. Independent predictors of in-hospital death were: age, cardiogenic shock, elevated cardiac markers and pharmacotherapy index. CONCLUSIONS: Advanced age is associated with less aggressive pharmacological treatment and higher in-hospital mortality in NSTE ACS patients remaining in community hospitals for conservative treatment. Broader implementation of current guidelines and more frequent invasive treatment might improve the outcomes of NSTE ACS patients regardless of age.
BACKGROUND: The purpose was to assess age-related differences in hospital management and mortality in non-ST-elevation acute coronary syndrome (NSTE ACS) patients treated conservatively, with a focus on the influence of aggressive pharmacological treatment on in-hospital clinical outcome. METHODS: We identified 807 NSTE ACSpatients treated conservatively in the 29 hospitals participating in the Krakow Registry of Acute Coronary Syndromes from February to March 2005 and from December 2005 to January 2006. Out of 807 patients' 32.1% were less than 65 years of age, 33% from 65 to 74, 30.5% from 75 to 84, and 5.3% >or= 85. For all patients, pharmacotherapy index based on the use of pharmacological treatment regimen during hospital stay was assessed. Each patient received 1 point for each of the following guideline-recommended drugs used: aspirin, clopidogrel, glycoprotein IIb/IIIa inhibitor, LMWH, beta-blocker, ACE inhibitor/angiotensin II receptor blocker and statin - the range of points being from 0 to 7. RESULTS: Significant age-related differences in baseline characteristics and pharmacotherapy index values were found. In-hospital mortality was higher in elderly patients (2.4% vs. 3.4% vs. 8.9% vs. 14.0%, respectively for age groups, p < 0.0001). Similarly, in non-shockpatients and in patients with elevated cardiac markers, age-dependent differences in mortality were observed. Independent predictors of in-hospital death were: age, cardiogenic shock, elevated cardiac markers and pharmacotherapy index. CONCLUSIONS: Advanced age is associated with less aggressive pharmacological treatment and higher in-hospital mortality in NSTE ACSpatients remaining in community hospitals for conservative treatment. Broader implementation of current guidelines and more frequent invasive treatment might improve the outcomes of NSTE ACSpatients regardless of age.
Authors: Artur Dziewierz; Dawid Giszterowicz; Zbigniew Siudak; Tomasz Rakowski; Jacek S Dubiel; Dariusz Dudek Journal: Clin Res Cardiol Date: 2010-05-11 Impact factor: 5.460
Authors: David D McManus; Joel Gore; Jorge Yarzebski; Frederick Spencer; Darleen Lessard; Robert J Goldberg Journal: Am J Med Date: 2011-01 Impact factor: 4.965
Authors: David D McManus; Marcello Chinali; Jane S Saczynski; Joel M Gore; Jorge Yarzebski; Frederick A Spencer; Darleen Lessard; Robert J Goldberg Journal: Am J Cardiol Date: 2011-02-01 Impact factor: 2.778