bout benefits and risks of invasive treatments are more pronounced in the setting of a very advanced age and concomitant acute coronary syndrome (ACS). This retrospective, cohort study aims to provide insights into the short-term survival of ACS patients undergoing percutaneus coronary intervention (PCI) in relation to age (70 to 85, and ≥85 years). Methods: Between 2010 and 2015, 4,041 patients ≥ 70 years old (mean age 76.5 ± 4.9 years, 54.9% male) were admitted with a diagnosis of ACS at 57 hospitals included in the network of the ISACS-TC registry (ClinicalTrials.gov, NCT01218776). Of these patients 302 (7.5%) were over 85 years old. The primary end-point was all cause 30 day mortality. Results: 1,699 elderly patients underwent PCI (42%). Thirty day mortality rates were 14.7% (268 patients) in women and 12.2% (271 patients) in men. The rate of death was greater in the very-elderly (≥85 years) than in the young-elderly (≥ 70 years, but <85 years) (24.2% vs 12.5%, P<0.001; OR: 2.24, 95% CI: 11.69-2.96). Following multi-variable analysis, age≥85 (odds ratio [OR] 2.03, 95% confidence interval [CI] 1.31 to 3.13), Killip class ≥II (OR 5.21, 95% CI 3.85 to 7.06) and chronic kidney disease (OR 2.08, 95% CI 1.46 to 2.98) emerged as independent predictors of 30 day mortality rates. PCI within 24 hours from admission was a predictor of survival (OR 0.55, 95% CI 0.39 to 0.77). Difference in mortality between very-elderly and young-elderly was no longer observed, when time from symptom onset to admission ≤60 minutes was included in the analysis (OR: 1.60, 95%CI 0.68-3.76). PCI remained a predictor of survival (OR 0.49, 95% CI 0.26 to 0.94). Conclusions: PCI appears to be a safe treatment option in the elderly and very elderly patients, provided that they are timely admitted to hospital. The selection of the optimal therapeutic strategy seems to be determined more by time to hospital presentation than by age.
Ricci, B., Cenko, E., Vasiljevic, Z., Dorobantu, M., Kedev, S., Gustiene, O., et al. (2016). DELAY TO HOSPITAL ADMISSION AND ACUTE CORONARY CARE IN THE ELDERLY AND IN THE VERY ELDERLY. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 67(13), 612-612 [10.1016/S0735-1097(16)30613-1].
DELAY TO HOSPITAL ADMISSION AND ACUTE CORONARY CARE IN THE ELDERLY AND IN THE VERY ELDERLY
RICCI, BEATRICE;CENKO, EDINA;MANFRINI, OLIVIA;BUGIARDINI, RAFFAELE
2016
Abstract
bout benefits and risks of invasive treatments are more pronounced in the setting of a very advanced age and concomitant acute coronary syndrome (ACS). This retrospective, cohort study aims to provide insights into the short-term survival of ACS patients undergoing percutaneus coronary intervention (PCI) in relation to age (70 to 85, and ≥85 years). Methods: Between 2010 and 2015, 4,041 patients ≥ 70 years old (mean age 76.5 ± 4.9 years, 54.9% male) were admitted with a diagnosis of ACS at 57 hospitals included in the network of the ISACS-TC registry (ClinicalTrials.gov, NCT01218776). Of these patients 302 (7.5%) were over 85 years old. The primary end-point was all cause 30 day mortality. Results: 1,699 elderly patients underwent PCI (42%). Thirty day mortality rates were 14.7% (268 patients) in women and 12.2% (271 patients) in men. The rate of death was greater in the very-elderly (≥85 years) than in the young-elderly (≥ 70 years, but <85 years) (24.2% vs 12.5%, P<0.001; OR: 2.24, 95% CI: 11.69-2.96). Following multi-variable analysis, age≥85 (odds ratio [OR] 2.03, 95% confidence interval [CI] 1.31 to 3.13), Killip class ≥II (OR 5.21, 95% CI 3.85 to 7.06) and chronic kidney disease (OR 2.08, 95% CI 1.46 to 2.98) emerged as independent predictors of 30 day mortality rates. PCI within 24 hours from admission was a predictor of survival (OR 0.55, 95% CI 0.39 to 0.77). Difference in mortality between very-elderly and young-elderly was no longer observed, when time from symptom onset to admission ≤60 minutes was included in the analysis (OR: 1.60, 95%CI 0.68-3.76). PCI remained a predictor of survival (OR 0.49, 95% CI 0.26 to 0.94). Conclusions: PCI appears to be a safe treatment option in the elderly and very elderly patients, provided that they are timely admitted to hospital. The selection of the optimal therapeutic strategy seems to be determined more by time to hospital presentation than by age.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
