Impact of age on management and outcome of acute coronary syndrome: Observations from the global registry of acute coronary events (GRACE)

Avezum, Álvaro; Makdisse, Márcia; Spencer, Frederick A.; Gore, Joel M.; Fox, Keith A.A.; Montalescot, Gilles; Eagle, Kim A.; White, Kami; Mehta, Rajendra H.; Knobel, E; Collet, Jean Philippe

doi:10.1016/j.ahj.2004.06.003

Cited by 513 publications

(422 citation statements)

References 29 publications

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“…The demographic and clinical profiles of the young patients enrolled in the ISACS‐TC registry are comparable with those of young patients in other large studies of patients with ACS 3, 7, 26. The present study showed that ≈8% of all patients hospitalized with ACS were aged ≤45 years.…”

Section: Discussionsupporting

confidence: 55%

“…The present study showed that ≈8% of all patients hospitalized with ACS were aged ≤45 years. In the GRACE (Global Registry of Acute Coronary Events) study, the frequency of young patients with ACS was 6.3%7; in the Thai ACS Registry and the ACS Spain Registry, the proportion of young people with ACS was 5.8% and 7%, respectively 3, 26. The mean age of our young ACS cohort was 40.3±6 years, which is consistent with prior work 1, 3, 7.…”

Section: Discussionmentioning

confidence: 99%

“…In the GRACE (Global Registry of Acute Coronary Events) study, the frequency of young patients with ACS was 6.3%7; in the Thai ACS Registry and the ACS Spain Registry, the proportion of young people with ACS was 5.8% and 7%, respectively 3, 26. The mean age of our young ACS cohort was 40.3±6 years, which is consistent with prior work 1, 3, 7. Sex distribution also followed a pattern already observed in previous studies, with a lower percentage of women in the young‐age group 1, 3, 7…”

Section: Discussionmentioning

confidence: 99%

“…Forty‐five years as the upper limit of defining young adults has been used in various studies and appears to be a reasonable boundary 1, 2, 3, 4, 5, 6, 7, 8, 9, 10. The same age definition has been, therefore, used in the current study on clinical characteristics and outcomes of ACS in young adults.…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, there is a paucity of studies on ACS in the young adults defined as previously described,1, 2, 3, 4, 5, 6, 7, 8, 9, 10 and the records of these analyses are often dated. The most known of these studies is based on the Get With the Guidelines‐Coronary Artery Disease registry data 1.…”

Section: Introductionmentioning

confidence: 99%

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Acute Coronary Syndrome: The Risk to Young Women

Ricci

Cenko

Vasiljević

et al. 2017

JAHA

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BackgroundAlthough acute coronary syndrome (ACS) mainly occurs in patients >50 years, younger patients can be affected as well. We used an age cutoff of 45 years to investigate clinical characteristics and outcomes of “young” patients with ACS.Methods and ResultsBetween October 2010 and April 2016, 14 931 patients with ACS were enrolled in the ISACS‐TC (International Survey of Acute Coronary Syndromes in Transitional Countries) registry. Of these patients, 1182 (8%) were aged ≤45 years (mean age, 40.3 years; 15.8% were women). The primary end point was 30‐day all‐cause mortality. Percentage diameter stenosis of ≤50% was defined as insignificant coronary disease. ST‐segment–elevation myocardial infarction was the most common clinical manifestation of ACS in the young cases (68% versus 59.6%). Young patients had a higher incidence of insignificant coronary artery disease (11.4% versus 10.1%) and lesser extent of significant disease (single vessel, 62.7% versus 46.6%). The incidence of 30‐day death was 1.3% versus 6.9% for the young and older patients, respectively. After correction for baseline and clinical differences, age ≤45 years was a predictor of survival in men (odds ratio, 0.24; 95% confidence interval, 0.10–0.58), but not in women (odds ratio, 1.35; 95% confidence interval, 0.50–3.62). This pattern of reversed risk among sexes held true after multivariable correction for in‐hospital medications and reperfusion therapy. Moreover, younger women had worse outcomes than men of a similar age (odds ratio, 6.03; 95% confidence interval, 2.07–17.53).Conclusion ACS at a young age is characterized by less severe coronary disease and high prevalence of ST‐segment–elevation myocardial infarction. Women have higher mortality than men. Young age is an independent predictor of lower 30‐day mortality in men, but not in women.Clinical Trial RegistrationURL: http://clinicaltrials.gov/. Unique identifier: NCT01218776.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute Coronary Syndrome: The Risk to Young Women

Ricci

Cenko

Vasiljević

et al. 2017

JAHA

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Cautionary Tales in the Interpretation of Clinical Studies Involving Older Persons

Scott

Guyatt²

2010

Arch Intern Med

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The care of patients 65 years or older presents a challenge for evidence-based medicine. Such patients are underrepresented in clinical trials, are more vulnerable to treatment-induced harm, and often are unable to fully participate in treatment decisions. We outline several cautionary themes in the interpretation of clinical studies of therapeutic interventions involving older persons as they apply to processes of everyday clinical decision making. In particular, we focus on issues of study design and quality of evidence, choice of outcome measures, missing outcome data, assessment of potential harm, quantifying treatment effects in individual patients (and adjusting these for effect modifiers and reduced life expectancy), eliciting patient values and preferences, prioritizing therapeutic goals and selection of treatments, and assisting patients in adhering to agreed therapeutic regimens.

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Effect of Simvastatin-Ezetimibe Compared With Simvastatin Monotherapy After Acute Coronary Syndrome Among Patients 75 Years or Older

et al. 2019

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IMPORTANCE Limited evidence is available regarding the benefit and hazard of higher-intensity treatment to lower lipid levels among patients 75 years or older. As a result, guideline recommendations differ for this age group compared with younger patients. OBJECTIVETo determine the effect on outcomes and risks of combination ezetimibe and simvastatin compared with simvastatin monotherapy to lower lipid levels among patients 75 years or older with stabilized acute coronary syndrome (ACS). DESIGN, SETTING, PARTICIPANTSIn this prespecified secondary analysis of the global, multicenter, prospective clinical randomized Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT), outcomes and risks were compared by age among patients 50 years or older after a hospitalization for ACS. Data were collected from using Kaplan-Meier curves and Cox proportional hazards models.INTERVENTIONS Double-blind randomized assignment to combined simvastatin and ezetimibe or simvastatin and placebo with follow-up for a median of 6 years (interquartile range, 4.3-7.1 years). MAIN OUTCOMES AND MEASURESThe primary composite end point consisted of death due to cardiovascular disease, myocardial infarction (MI), stroke, unstable angina requiring hospitalization, and coronary revascularization after 30 days. Individual adverse ischemic and safety end points and lipid variables were also analyzed. RESULTSOf 18 144 patients enrolled (13 728 men [75.7%]; mean [SD] age, 64.1 [9.8] years), 5173 (28.5%) were 65 to 74 years old, and 2798 (15.4%) were 75 years or older at randomization. Treatment with simvastatin-ezetimibe resulted in lower rates of the primary end point than simvastatin-placebo,including0.9%forpatientsyoungerthan65years(HR,0.97;95%CI,0.90-1.05) and 0.8% for patients 65 to 74 years of age (hazard ratio [HR], 0.96; 95% CI, 0.87-1.06), with the greatest absolute risk reduction of 8.7% for patients 75 years or older (HR, 0.80; 95% CI, 0.70-0.90) (P = .02 for interaction). The rate of adverse events did not increase with simvastatin-ezetimibe vs simvastatin-placebo among younger or older patients. CONCLUSIONS AND RELEVANCEIn IMPROVE-IT, patients hospitalized for ACS derived benefit from higher-intensity therapy to lower lipid levels with simvastatin-ezetimibe compared with simvastatin monotherapy, with the greatest absolute risk reduction among patients 75 years or older. Addition of ezetimibe to simvastatin was not associated with any significant increase in safety issues among older patients. These results may have implications for guideline recommendations regarding lowering of lipid levels in the elderly. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00202878JAMA

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Impact of age on management and outcome of acute coronary syndrome: Observations from the global registry of acute coronary events (GRACE)

Cited by 513 publications

References 29 publications

Acute Coronary Syndrome: The Risk to Young Women

Acute Coronary Syndrome: The Risk to Young Women

Cautionary Tales in the Interpretation of Clinical Studies Involving Older Persons

Effect of Simvastatin-Ezetimibe Compared With Simvastatin Monotherapy After Acute Coronary Syndrome Among Patients 75 Years or Older

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