Preferences regarding invasive diagnostic procedures in patients aged 70 years or over presenting with acutecoronary syndrome and relationship with short-term mortality

OBJECTIVES
We prospectively classified patients presenting with acute coronary syndrome (ACS) into two age groups, <70 years and ≥70 years, and investigated the frequency of cardiac catheterization, the predictors of cardiac catheterization in the older patient population, and determined early mortality in patients treated with or without cardiac catheterization.

STUDY DESIGN
The study included 1,101 patients admitted with ACS. The patients were prospectively classified in two age groups, <70 years (n=762; mean age 55±9 years) and ≥70 years (n=339; mean age 76±5 years). Data on demographic characteristics, clinical and laboratory findings, and the presence or absence of cardiac catheterization were recorded. The predictors of cardiac catheterization were assessed in the overall patient group and in those ≥70 years of age, and 30-day mortality rates were determined.

RESULTS
Compared with the older group, in younger patients cardiac catheterization was more frequent (74.4% vs. 50.7%, p=0.0001) and earlier (p=0.023), and decision for percutaneous coronary intervention was more common (52.7% vs. 40.7%, p=0.010), whereas coronary bypass grafting was performed more frequently in the older group (43% vs. 31.2%, p=0.010). Overall 30-day mortality rates showed significant differences in both groups between patients treated with or without cardiac catheterization (<70 years: 3.7% vs. 18.3%, p<0.0001; ≥70 years: 5.6% vs. 21%, p<0.0001). Logistic regression analysis showed the following as significant predictors of cardiac catheterization in patients ≥70 years of age: heart failure (OR: 3.853, p=0.017), systolic blood pressure <100 mmHg (OR: 3.602, p=0.008), creatinine clearance <60 ml/min (OR: 2.761, p=0.001), and ST-segment elevation ≥1 mm on the electrocardiogram (OR: 2.817, p=0.0001).

CONCLUSION
Invasive diagnostic and therapeutic strategies are implemented less frequently in elderly patients. These procedures, which offer obvious mortality benefit, should be considered in elderly patients after meticulous risk evaluation.