TY - JOUR
T1 - Acute coronary syndrome in the elderly
T2 - the Malaysian National Cardiovascular Disease Database-Acute Coronary Syndrome registry
AU - Zuhdi, Ahmad Syadi Mahmood
AU - Ahmad, Wan Azman Wan
AU - Zaki, Rafdzah Ahmad
AU - Mariapun, Jeevitha
AU - Ali, Rosli Mohd
AU - Sari, Norashikin Md
AU - Ismail, Muhammad Dzafir
AU - Hian, Sim Kui
N1 - Publisher Copyright:
© 2016, Singapore Medical Association. All Rights Reserved.
Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2016/4
Y1 - 2016/4
N2 - Introduction The elderly are often underrepresented in clinical trials for acute coronary syndrome (ACS), and cardiologists commonly face management dilemmas in the choice of treatment for this group of patients, particularly concerning the use of invasive revascularisation. This study analysed the characteristics of hospitalised elderly patients with ACS, and compared the outcomes of treatments. Methods From 29 December 2005 to 26 April 2010, 13,545 patients were admitted for ACS in 16 hospitals across Malaysia. These patients were divided into two groups – elderly (≥ 65 years) and non-elderly (< 65 years). The clinical characteristics, treatment received (invasive or non-invasive) and outcomes (in-hospital and 30-day all-cause mortality) of the two groups were compared. The elderly patients were then grouped according to the type of treatment received, and the outcomes of the two subgroups were compared. Results Elderly patients had a higher cardiovascular risk burden and a higher incidence of comorbidities. They were less likely to receive urgent revascularisation for acute ST-segment elevation myocardial infarction (elderly: 73.9% vs. non-elderly: 81.4%) and had longer door-to-needle time (elderly: 60 minutes vs. non-elderly: 50 minutes, p = 0.004). The rate of cardiac catheterisation was significantly lower in the elderly group across all ACS strata. Elderly patients had poorer outcomes than non-elderly patients, but those who received invasive treatment appeared to have better outcomes than those who received non-invasive treatment. Conclusion Elderly patients with ACS tend to be undertreated, both invasively and pharmacologically. Invasive treatment seems to yield better outcomes for this group of patients.
AB - Introduction The elderly are often underrepresented in clinical trials for acute coronary syndrome (ACS), and cardiologists commonly face management dilemmas in the choice of treatment for this group of patients, particularly concerning the use of invasive revascularisation. This study analysed the characteristics of hospitalised elderly patients with ACS, and compared the outcomes of treatments. Methods From 29 December 2005 to 26 April 2010, 13,545 patients were admitted for ACS in 16 hospitals across Malaysia. These patients were divided into two groups – elderly (≥ 65 years) and non-elderly (< 65 years). The clinical characteristics, treatment received (invasive or non-invasive) and outcomes (in-hospital and 30-day all-cause mortality) of the two groups were compared. The elderly patients were then grouped according to the type of treatment received, and the outcomes of the two subgroups were compared. Results Elderly patients had a higher cardiovascular risk burden and a higher incidence of comorbidities. They were less likely to receive urgent revascularisation for acute ST-segment elevation myocardial infarction (elderly: 73.9% vs. non-elderly: 81.4%) and had longer door-to-needle time (elderly: 60 minutes vs. non-elderly: 50 minutes, p = 0.004). The rate of cardiac catheterisation was significantly lower in the elderly group across all ACS strata. Elderly patients had poorer outcomes than non-elderly patients, but those who received invasive treatment appeared to have better outcomes than those who received non-invasive treatment. Conclusion Elderly patients with ACS tend to be undertreated, both invasively and pharmacologically. Invasive treatment seems to yield better outcomes for this group of patients.
KW - Acute coronary syndrome
KW - Cardiovascular
KW - Elderly
KW - Mortality
KW - Percutaneous coronary intervention
UR - http://www.scopus.com/inward/record.url?scp=84964077443&partnerID=8YFLogxK
U2 - 10.11622/smedj.2015145
DO - 10.11622/smedj.2015145
M3 - Article
C2 - 26768171
AN - SCOPUS:84964077443
SN - 0037-5675
VL - 57
SP - 191
EP - 197
JO - Singapore Medical Journal
JF - Singapore Medical Journal
IS - 4
ER -