Jonathan Buber1, Ilan Goldenberg, Lizzie Kimron, Victor Guetta. 1. Sheba Medical Center and the Neufeld Cardiac Research Institute, Leviev Heart Institute, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel. yonibuber@gmail.com
Abstract
OBJECTIVES: We aimed to evaluate the management and outcomes of patients of the octogenarian age group with non-ST elevation myocardial infarction (NSTEMI) in a real-world setting. METHODS: The risk of 30-day and 1-year mortality by age and the time of coronary angiography [categorized as early (≤48 h of admission) and late (>48 h of admission)] was assessed among 2021 NSTEMI patients enrolled in the Acute Coronary Syndrome Israeli Survey (ACSIS) between 2004 and 2008. RESULTS: Elderly patients (≥80 years) comprised almost 20% of the study population, and experienced a significantly higher rate of in-hospital complications. The risk of 1-year mortality was 3.4-fold (P<0.001) higher among octogenarian patients compared with younger patients. Multivariate analysis showed that among patients aged at least 80 years, utilization of revascularization was associated with a lower risk of death at 1 year [hazard ratio (HR)=0.50, P=0.004], but not at 30 days, compared with no angiography. However, referral for early coronary angiography was associated with a lower risk of death both at 30 days and at 1 year (HR=0.4, P=0.04 and HR=0.38, P=0.02, respectively). CONCLUSION: Our findings indicate that patients of the octogenarian age group comprise a high-risk subset of the NSTEMI population, in whom early referral for coronary angiography is independently associated with a lower risk of mortality at 30 days and 1 year.
OBJECTIVES: We aimed to evaluate the management and outcomes of patients of the octogenarian age group with non-ST elevation myocardial infarction (NSTEMI) in a real-world setting. METHODS: The risk of 30-day and 1-year mortality by age and the time of coronary angiography [categorized as early (≤48 h of admission) and late (>48 h of admission)] was assessed among 2021 NSTEMI patients enrolled in the Acute Coronary Syndrome Israeli Survey (ACSIS) between 2004 and 2008. RESULTS: Elderly patients (≥80 years) comprised almost 20% of the study population, and experienced a significantly higher rate of in-hospital complications. The risk of 1-year mortality was 3.4-fold (P<0.001) higher among octogenarian patients compared with younger patients. Multivariate analysis showed that among patients aged at least 80 years, utilization of revascularization was associated with a lower risk of death at 1 year [hazard ratio (HR)=0.50, P=0.004], but not at 30 days, compared with no angiography. However, referral for early coronary angiography was associated with a lower risk of death both at 30 days and at 1 year (HR=0.4, P=0.04 and HR=0.38, P=0.02, respectively). CONCLUSION: Our findings indicate that patients of the octogenarian age group comprise a high-risk subset of the NSTEMI population, in whom early referral for coronary angiography is independently associated with a lower risk of mortality at 30 days and 1 year.
Authors: Audrey L Blewer; Mary E Putt; Lance B Becker; Barbara J Riegel; Jiaqi Li; Marion Leary; Judy A Shea; James N Kirkpatrick; Robert A Berg; Vinay M Nadkarni; Peter W Groeneveld; Benjamin S Abella Journal: Circ Cardiovasc Qual Outcomes Date: 2016-10-04
Authors: Pamela Ouyang; Nanette K Wenger; Doris Taylor; Janet W Rich-Edwards; Meir Steiner; Leslee J Shaw; Sarah L Berga; Virginia M Miller; Noel Bairey Merz Journal: Biol Sex Differ Date: 2016-03-31 Impact factor: 5.027