Losin Ilya, Giladi Ela, Arow Ziad, Hilu Ranin, Ovdat Tal, Assali Abid, Pereg David
Cardiology Department, Meir Medical Center, Kfar Saba.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Coron Artery Dis. 2025 Jan 1;36(1):65-69. doi: 10.1097/MCA.0000000000001427. Epub 2024 Sep 27.
Nonagenarians are a fast-growing age group among acute coronary syndrome (ACS) patients. While new therapeutic options have improved outcomes of ACS patients, data regarding very elderly ACS patients are limited. We aimed to evaluate temporal trends in the treatment and outcomes of nonagenarian ACS patients.
Included were ACS patients aged below 90 years enrolled in ACS Israeli Survey. Patients were divided into two groups according to enrolment period: early (2000-2010) and recent (2012-2021). The primary endpoints were 30-day major adverse cardiovascular events and all-cause mortality. Secondary outcomes included in-hospital and 1-year all-cause mortality.
Included were 316 elderly ACS patients. Of them, 184 were enrolled in the early and 132 in recent surveys. Patients enrolled in the recent period were more commonly referred for an invasive strategy and more commonly received guideline-based medical therapy. All-cause mortality at 30 days was significantly lower in the recent group compared with the early group (12.5 and 26.1%, respectively, P = 0.005). Rates of 30-day major adverse cardiovascular events were also significantly lower in the recent group (21.9 and 35.9%, respectively, P = 0.012). Patients in the recent group received more aggressive medical therapy in discharge but at 30-day follow-up, no difference in medical treatment was observed in the two groups. There were no significant differences in 1-year mortality rates.
Treatment of nonagenarians with ACS has improved over the past decade. Treatment improvement was associated with a significant improvement in 30-day outcomes without any effect in 1 year. Nevertheless, even with contemporary treatment, nonagenarians with ACS remain a high-risk group with high mortality rates.
在急性冠状动脉综合征（ACS）患者中，九旬老人是一个快速增长的年龄组。虽然新的治疗选择改善了ACS患者的治疗效果，但关于高龄ACS患者的数据有限。我们旨在评估九旬老人ACS患者治疗和结局的时间趋势。
纳入参加以色列ACS调查的90岁以下ACS患者。根据入组时间将患者分为两组：早期（2000 - 2010年）和近期（2012 - 2021年）。主要终点是30天主要不良心血管事件和全因死亡率。次要结局包括住院期间和1年全因死亡率。
纳入316例老年ACS患者。其中，184例在早期调查中入组，132例在近期调查中入组。近期入组的患者更常被推荐采用侵入性策略，更常接受基于指南的药物治疗。近期组30天全因死亡率显著低于早期组（分别为12.5%和26.1%，P = 0.005）。近期组30天主要不良心血管事件发生率也显著更低（分别为21.9%和35.9%，P = 0.012）。近期组患者出院时接受了更积极的药物治疗，但在30天随访时，两组药物治疗无差异。1年死亡率无显著差异。
在过去十年中，九旬老人ACS的治疗有所改善。治疗改善与30天结局的显著改善相关，对1年结局无影响。然而，即使采用当代治疗，九旬老人ACS患者仍然是高风险组，死亡率高。
