Predictors of Mortality in Elderly Patients with Non-ST Elevation Acute Coronary Syndrome - Data from Taiwan Acute Coronary Syndrome Full Spectrum Registry.

BACKGROUND

Some difficulties and variations remain associated with the care of elderly patients with non-ST elevation acute coronary syndrome (NSTE-ACS).

METHODS

We included 1470 patients from a Taiwan nationwide registry who fulfilled the criteria of NSTE-ACS, and stratified these patients by age and evaluated the treatment, complications and outcomes in different age groups. Furthermore, we analyzed risk factors and standards of care to determine the predictors of mortality.

RESULTS

Patients ≥ 75 years of age (n = 396) had significantly higher incidences of 90-day mortality [odd ratio (OR) = 4.5 (1.2-16.3), p = 0.023] and 1-year mortality [OR = 4.9 (2.0-12.3), p = 0.001] compared with those patients 45-64 years of age (n = 595). In the patients ≥ 75 years of age, previous myocardial infarction (MI) [OR = 3.3 (1.1-9.8), p = 0.035], statins [OR = 0.35 (0.1-0.9), p = 0.037], left ventricular ejection fraction (LVEF) < 35% [OR = 3.9 (1.5-10.4), p = 0.006] were associated with 90-day mortality. Furthermore, previous MI [OR = 4.0 (1.3-12.6), p = 0.019] was an independent predictor of 90-day mortality. Age [OR = 1.1 (1.03-1.2), p = 0.002], previous MI [OR = 2.2 (1.1-4.4), p = 0.034], angiotensin-converting enzyme inhibitor or angiotensin receptor blocker [OR = 0.5 (0.3-0.9), p = 0.028], and LVEF < 35% [OR = 4.3 (1.9-9.5), p < 0.001] were associated with 1-year mortality. Furthermore, previous MI [OR = 2.6 (1.1-6.5), p = 0.037], LVEF < 35% [OR = 4.7 (1.5-14.4), p = 0.007] and percutaneous coronary intervention(PCI) or not [OR = 0.3 (0.1-0.9), p = 0.021] were independent predictors of 1-year mortality.

CONCLUSIONS

Previous MI, LVEF < 35% and PCI or not could predict 1-year mortality in advanced elderly patients with NSTE-ACS. Despite their elevated morbidities and complications, PCI was still beneficial for these patients.