Improved short and long term survival associated with percutaneous coronary intervention in the elderly patients with acute coronary syndrome

Abstract

BackgroundPercutaneous coronary intervention (PCI) are increasingly used in daily clinical practice in elderly patients with acute coronary syndrome (ACS) despite limited evidence. The purpose of this study was to assess the impact of PCI on short and long term survivals in a large cohort of elderly patients with ACS from a “real world”.MethodsWe enrolled 491 patients aged ≥70 years admitted to our institution with ACS from 2006 to 2012. Effect of PCI on short and long term survival was evaluated in both overall and a propensity score-matched cohort.ResultsThe mean age of the overall cohort is 83 ± 6 years. Among them, 285 were treated with PCI, whereas 206 were not. Patients treated with PCI were younger (82 ± 5 vs. 85 ± 6), more males (67% vs. 46%), with lower heart rate (77 ± 22 vs. 84 ± 21), higher eGFR (58 ± 20 vs. 47 ± 23), and less with heart failure (29% vs. 15%) (all p < 0.001). In both overall and propensity-matched population, improved survival was associated with PCI-treatment at 1 and 3 years (p < 0.001 for all comparisons). Furthermore, by using multivariate Cox proportional-hazards regression model following factors were identified as independent predictors of 3-year all-cause mortality: age (HR 1.08, 95% CI 1.00–1.16), heart rate (HR 1.02, 95% CI 1.01–1.03), eGFR (HR 3.07, 95% CI 1.63–5.77), malignancy (HR 2.03, 95% CI 1.27–4.57), prior CABG (HR 2.033, 95% CI 1.27–4.57), medication with statin (HR 0.40, 95% CI 0.19–0.86) in PCI group, whereas age (HR 1.08, 95% CI 1.03–1.13), heart rate (HR 1.01, 95% CI 1.01–1.02), hypertension (HR 1.87, 95% CI 1.01–3.49) and using of ACEI/ARB (HR 0.46, 95% CI 0.28–0.76) in non-PCI group.ConclusionsIn elderly ACS patients, PCI-treatment was associated with improved 1 and 3-year survival and PCI-treated patients had different prognostic profile compared to those without PCI treatment.

Killip-Kimball Classification Validation, Outcomes and Demographics in an Octogenarian Cohort with Acute Coronary Syndrome in a Developing Country: A Third-Level Multicenter 11-Year Experience

“…These findings further solidify the decision to aggressively treat elderly patients with ACS, rather than utilizing a conservative approach as well as determine a more reliable prognosis after a interventional procedure. (16,17) Our study strengthens the growing literature supporting the use of KC as an in-hospital mortality prognostic indicator. We also describe how this classification relates to other paraclinical studies and laboratory values.…”

Recovery Rate and Predictors Among Patients with Acute Coronary Syndrome in Addis Ababa, Ethiopia: A Retrospective Cohort Study

“…29 PCI treatment was also reported to increase the overall survival of ACS elderly patients. 34 In this study, hypertension, diabetes mellitus and heart failure were the commonest comorbidities of study subjects. The current findings are line with study results in Kenya where type 2 diabetes and hypertension were the main comorbidities associated with ACS.…”

Socioeconomic Status, Mortality, and Access to Cardiac Services After Acute Myocardial Infarction in Canada: A Systematic Review and Meta-analysis

“… 8 , 10 , 12 At the care-delivery level, the advent of invasive catheterization and the incorporation of cardiac rehabilitation into standard post–myocardial infarction care has revolutionized cardiovascular health, leading to significant improvements in mortality and quality of life. 4 , 13 , 14 , 15 However, whether patients across the SES spectrum have equal opportunity to access these therapies remains unclear, 10 , 16 despite 2 prior systematic reviews on this topic. 17 , 18 Quatromoni et al.…”