Research Papers: Gerotarget (Focus on Aging):
Therapeutic management and one-year outcomes in elderly patients with acute coronary syndrome
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Esteban Orenes-Piñero1, Juan M. Ruiz-Nodar2, María Asunción Esteve-Pastor1, Miriam Quintana-Giner1, José Miguel Rivera-Caravaca1, Andrea Veliz1, Mariano Valdés1, Manuel Macías2, Vicente Pernias-Escrig3, Nuria Vicente-Ibarra3, Luna Carrillo2, Miriam Sandín-Rollán2, Elena Candela2, Teresa Lozano2 and Francisco Marín1
1 Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, (IMIB-Arrixaca), Universidad de Murcia, Murcia, Spain
2 Department of Cardiology, Hospital General Universitario de Alicante, Alicante, Spain
3 Department of Cardiology, Hospital General Universitario de Elche, Alicante, Spain
Esteban Orenes-Piñero, email:
Keywords: acute coronary syndrome, elderly, antiplatelet therapy, revascularization, follow-up, Gerotarget
Received: July 04, 2017 Accepted: August 27, 2017 Published: September 24, 2017
Background: Elderly represents a subgroup of high-risk ACS patients due to their advanced age and other comorbidities. Unfortunately, they are also often under-represented in many studies and clinical trials. Furthermore, cardiologists commonly find difficulties in the choice of the antiplatelet treatment and even on whether invasive revascularization should be used. In this study, the management of elderly ACS patients regarding antiplatelet therapy and revascularization procedures will be analyzed.
Methods: 1717 ACS patients were consecutively included in this study from 3 tertiary Hospitals in the Southeast of Spain. Of them, 529 (30.8%) were ≥ 75 years. They were mainly male (60.7%) with a mean age of 81.4±4.7 years. Clinical characteristics, treatment received (antiaplatelet therapy, revascularization) and outcome were analyzed.
Results: Regression analysis showed that being ≥ 75 years is independently associated with neither performing catheterization (79.6% vs 97.1%), nor revascularization (51.8% vs 72.5%), being the medical conservative treatment the election in these elderly patients (40.6% vs 18.9%) (p < 0.001 for all). Furthermore, ticagrelor prescription were significantly decreased in older patients (11.5% vs 19.6%; p < 0.001). Regarding patients outcome after one-year of follow-up, being ≥ 75 years was associated with death, major adverse cardiac events (MACE) and major bleeding (all of them p < 0.001). Importantly, nor performing catheterization was independently associated with MACE and death in Cox multivariate analysis in elderly patients.
Conclusions: Elderly patients with ACS are undertreated both invasively and pharmacologically, and this fact might be associated with the observed worse outcomes.
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