Non-ST elevation acute coronary syndromes; clinical landscape, management strategy and in-hospital outcomes: an age perspective

Abstract

Background As the elderly represent a substantial proportion of medical care beneficiaries, and there is limited data about age disparity in emerging countries, this study sought to investigate the impact of age on the management in patients with non-ST elevation acute coronary syndromes (NSTE-ACS). Results Two hundred patients with NSTE-ACS enrolled prospectively, patients’ data, pharmacotherapy, management strategy as well timing to catheterization were documented. Patients grouped into ≥ 65 years versus < 65 years; 32.5% were ≥ 65-year-old. The older group presented as high GRACE risk (Global Registry of Acute Coronary Events) (67.7% versus 15.6%). Elderly patients were less likely to be referred for catheterization compared with younger counterparts (55.4% versus 76.3%, p = 0.003). Within low risk class patients, none of the elderly versus 9.33% of younger patients were catheterized within 2 h; in the same line, none of the elderly versus 16% of younger patients were catheterized within 24 h. Alternatively, at high risk class, 6.81% of the elderly and none of the younger patients were catheterized within 2 h. On the univariate analysis of variables to predict invasive strategy, presence of history of prior IHD, diabetes, absent in-hospital acute heart failure or atrial fibrillation/flutter, higher haemoglobin and lower creatinine levels predicted the use of invasive strategy, while on multivariate analysis, acute heart failure (95% CI − 0.38 to − 0.41, p = 0.01), lower haemoglobin (95% CI 0.002–0.07, p = 0.03), and atrial fibrillation/flutter (95% CI − 0.48 to − 0.02, p = 0.03) predicted conservative strategy. The elderly were more likely to have acute heart failure (32.3% versus 14.8%, p = 0.004), same as stroke (3.1% versus none, p = 0.04). Conclusions Less-invasive strategy used in the elderly with NSTE-ACS compared with younger counterparts, yet age was not a predictor of catheterization underuse on multivariate analysis. It is crucial to bridge the age gap in the healthcare system in setting of ACS management by grasping the attention of decision makers and emphasizing on the adherence of healthcare providers to the guidelines to improve cardiovascular care and outcomes.

Clinico-angiographic profiles and in-hospital outcomes of non-ST segment elevation myocardial infarction in Kurdistan Region of Iraq

“…Such finding was also seen by Butt et al and Rahmani et al 28,39 The cardiovascular complications and death rates were also higher among GRACE scores of ≥ 140 with P values (<0.001 for each). These findings were almost similar to rates found by Dakhil et al 27 and Kumar et al 40…”

“…In comparisons between conservative and intervention groups, the study showed that the younger age groups had a significantly higher rate of intervention than the elderly group (P < 0.001). This was comparable to Dakhil et al 27 Those with higher GRACE scores received more intervention than cases with lower GRACE scores (P < 0.001). This was comparable to other studies, including Martinez et al in Spain.…”

“…The most common one was heart failure, followed by arrhythmias. Its rates were comparable to the study by Dakhil et al 27 and was higher than the study by Butt et al 28 Regarding NSTEMI mortality, the study demonstrated that the mortality rate was 7.4%. This rate was almost similar to a study by Hamid et al from Iraq (7.7%), 29 but was higher than the GRACE registry (5%) 30 and Yusuf et al (3.3%).…”

Dropping risk stratification with subsequent treatment-risk paradox in non ST elevation acute coronary syndromes: a clinical audit in Iraq

“…This was the first designed clinical audit in cardiology field in Iraq. To date, in Iraq limited data is known about the extent of adherence of NSTE-ACS treating cardiac teams to the global guidelines regarding recommendations on risk stratification and subsequent performance of cardiac catheterization based on patients’ risk and within the recommended time frames for each risk category [ 12 ]. Moreover, this is the first study that actively and prospectively assessed use of risk scores adherence (i.e., not like prior studies that assessed use of risk scores from patients’ charts after discharge) for patients who were diagnosed as NSTE-ACS.…”