Age and clinical outcomes in patients presenting with acute coronary syndromes

Abstract

a b s t r a c tContext: Elderly patients have more cardiovascular risk factors and a greater burden of ischemic disease than younger patients. Aims: To examine the impact of age on clinical presentation and outcomes in patients presenting with acute coronary syndrome (ACS). Methods and material: Collected data from the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2), which is a prospective multicenter study from six adjacent Arab Middle Eastern Gulf countries. Patients were divided into 3 groups according to their age: 50 years, 51e70 years and >70 years and their clinical characteristics and outcomes were analyzed. Mortality was assessed at one and 12 months. Statistical analysis used: One-way ANOVA test for continuous variables, Pearson chi-square (X 2 ) test for categorical variables and multivariate logistic regression analysis for predictors were performed. Results: Among 7930 consecutive ACS patients; 2755 (35%) were 50 years, 4110 (52%) were 51e70 years and 1065 (13%) >70 years old. The proportion of women increased with increasing age (13% among patients 50 years to 31% among patients > 70 years). The risk factor pattern varied with age; younger patients were more often obese, smokers and had a positive family history of CAD, whereas older patients more likely to have diabetes mellitus, hypertension, and dyslipidemia. Advancing age was associated with under-treatment evidence-based therapies. Multivariate logistic regression analysis after adjusting for relevant covariates showed that old age was independent predictors for re-ischemia (OR 1.29; 95% CI 1.03e1.60), heart failure (OR 2.8; 95% CI 2.17e3.52) and major bleeding (OR 4.02; 95% CI 1.37 e11.77) and in-hospital mortality (age 51e70: OR 2.67; 95% CI 1.86e3.85, and age >70: OR 4.71; 95% CI 3.11e7.14). Conclusion: Despite being higher risk group, elderly are less likely to receive evidence-based therapies and had worse outcomes. Guidelines adherence is highly recommended in elderly.

Age related differences in acute coronary syndrome presentation and in hospital outcomes: a cross-sectional comparative study

“…In the present study ST-Segment Elevation Myocardial Infarction was more prevalent among the younger age group in agreement with Stem et al [ 5 ]. Hypertension was commoner among older patients and in agreement with Ahmed et al [ 3 ]. No significant statistical difference was found regarding diabetes mellitus, and prior myocardial infarction one plausible explanation is the closer age ranges in the two subgroups as only 12.6% of our samples were above 70 years old.…”

“…Furthermore, the expected mortality rate is higher. In spite of the American College of Cardiology/American Heart Association (ACC/AHA) guidelines statement that age should not influence patients cares elderly acute coronary syndrome patients benefit less from evidence-based therapy including interventional procedures [ 3 , 4 ]. There is an increasing awareness of the clinical presentation, ECG, and outcomes of acute coronary syndrome among elderly people due to expanding aging populations [ 5 ].…”

Global Perspective on Acute Coronary Syndrome

“…The available results from the OASIS-1 and -2 registries 95 and epidemiologic studies in India 96-98 suggest that earlier age for first ACS in LMICs is a major contributing factor. Registry data from many other LMICs also support the assertion that ACS often occur at younger ages than in HICs: 99-109 Strikingly, a registry from the United Arab Emirates reported a mean age of 50.8 years. 110 Earlier age for first ACS is likely due to earlier acquisition of adverse health behaviors and IHD risk factors 10,97,111,112 in the current context of economic development and globalization.…”

Platelet-to-lymphocyte ratio is a predictor of in-hospital mortality patients with acute coronary syndrome

“…Ahmed et al (45) demonstrated that older patients had a higher risk of adverse hospital outcomes and short- and long-term mortality rates with respect to younger patients. As shown in previous studies, we found that renal dysfunction, together with age and PLR, is independently related with inhospital mortality.…”