One-year outcome following coronary angiography in elderly patients with non-ST elevation myocardial infarction: real-world data from the Acute Coronary Syndromes Israeli Survey (ACSIS).

OBJECTIVES

We aimed to evaluate the management and outcomes of patients of the octogenarian age group with non-ST elevation myocardial infarction (NSTEMI) in a real-world setting.

METHODS

The risk of 30-day and 1-year mortality by age and the time of coronary angiography [categorized as early (≤48 h of admission) and late (>48 h of admission)] was assessed among 2021 NSTEMI patients enrolled in the Acute Coronary Syndrome Israeli Survey (ACSIS) between 2004 and 2008.

RESULTS

Elderly patients (≥80 years) comprised almost 20% of the study population, and experienced a significantly higher rate of in-hospital complications. The risk of 1-year mortality was 3.4-fold (P<0.001) higher among octogenarian patients compared with younger patients. Multivariate analysis showed that among patients aged at least 80 years, utilization of revascularization was associated with a lower risk of death at 1 year [hazard ratio (HR)=0.50, P=0.004], but not at 30 days, compared with no angiography. However, referral for early coronary angiography was associated with a lower risk of death both at 30 days and at 1 year (HR=0.4, P=0.04 and HR=0.38, P=0.02, respectively).

CONCLUSION

Our findings indicate that patients of the octogenarian age group comprise a high-risk subset of the NSTEMI population, in whom early referral for coronary angiography is independently associated with a lower risk of mortality at 30 days and 1 year.