Outcome of Acute Coronary Syndrome in Women ≥ 80 Years Versus Those < 80 Years in Israel from 2000 to 2016

Roy Rubinstein Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, -, Israel The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Shlomi Matetzky Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, -, Israel The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Roy Beigel Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, -, Israel The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Zaza Iakobishvili Cardiology Department, Rabin Medical Center, Petach Tiqva, Israel The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Ilan Goldenberg Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, -, Israel The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Michael Shechter Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, -, Israel The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel on behalf of the ACSIS invastigators The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Background: While patients ≥ 80 years old constitute the fastest growing segment of the population and have a high prevelance of coronary artery disease (CAD), few data are available regarding the outcome of women ≥ 80 years with acute coronary syndrome (ACS).

Methods: We evaluated in-hospital, 30-day and 1-year clinical outcome of 3,518 women patients [858 (24%) ≥ and 2,660 (76%) < 80 years old] from the Acute Coronary Syndrome Israel Survey (ACSIS), by analyzing data from ACS patients hospitalized in all coronary care units in Israel during a two-month periods/year during the period 2000-2016.

Results: ACS women ≥ 80 years (mean age 85±4) had a higher incidence of CAD risk factors, prior cardio-cerebrovascular events, chronic renal failure and greater cardiac medication use compared to patients < 80 years (mean age 66±10). Time from chest pain onset to hospitalization and myocardial infarction (MI) location were similar in both groups. Killip class on admission was higher, while left ventricular ejection fraction was lower in ACS women ≥ compared to < 80 years. ST elevation MI (STEMI) on admission was similar in both groups of ACS women. Throughout hospitalization ACS women ≥ 80 years received significantly less single and/or dual antiplatelet therapy, angiotensin-converting enzyme inhibitors, b-blockers and statins, but more calcium blockers, nitrates and diuretic therapy, compared to those < 80 years.

Age < 80 (n=2,660)

Age ≥ 80 (n=858)

P value

Any PCI in STEMI

601 (84%)

155 (67%)

<0.001

Any PCI in all patients

1212 (66%)

323 (55%)

<0.001

In-hospital mortality

121 (4.5%)

112 (13.1%)

<0.001

7-day mortality

83 (3.1%)

25 (9.4%)

<0.001

30-day mortality

142 (5.4%)

133 (15.7%)

<0.001

1-year mortality

247 (10.4%)

214 (28.6%)

<0.001

Multivariate Cox regression analysis demonstrated a worse 1-year survial rate in ACS women ≥ 80 years compare to those < 80 years. In addition, while comparing the outcome of ACS women ≥ 80 hospitalized during 2000-2006 (‘early’) period (n=450) to 2008-20016 (‘late’) period (n=408), in-hospital, but not 1-year mortality was significantly higher in the ‘early” compared to the “late’ period (15.6% vs 10.3, p=0.029; 31.3% vs 24.7%, p=0.059; respectively)

Conclusion: ACS women ≥ 80 years have significantly worse in-hospital, 7-day, 30-day and 1-year outcome compared to those < 80 years. However, during the “late” period, women ≥ 80 years were more frequently treated with guideline recommended therapies compared to women from the same age group who were hospitalized in the “early” period with a significantly lower in-hospital mortality and a trend towards a lower 1-year mortality in ACS women ≥ 80 years in the “late” vs the “early” period.









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