Background: Few data are available regarding the outcome of octogenarians with acute coronary syndrome (ACS).
Methods: We evaluated 30-day and 1-year clinical outcome of 1477 patients ≥ 80 years old (mean age 85±4, females 43%) from the ACS Israel Survey (ACSIS), by analyzing data from ACS patients hospitalized in all coronary care units in Israel during two-month periods/year during the period 2000 to 2006 (“early period”, n=1033) and compared to the period of 2008 to 2013 (“late period”, n=444).
Results: In the late period octogenarians were older (85±4 vs 84±4 years; p<0.01), had higher incidence of hypertension (85% vs 74%, p<0.01), diabetes (39% vs 30%, p<0.01), dyslipidemia (75% vs 41%, p<0.01), family history (8% vs 4%, p<0.01), prior myocardial infarctions (MI) (41% vs 36%, p<0.02), percutaneous coronary interventions (PCI) (37% vs 16%, p<0.01), and chronic renal disease (30% vs 24%, p<0.01) compared to those in the early period. Time from onset of chest pain to hospitalization and PCI were similar in both groups. Octogenarians from the early period had higher frequency of anterior MI (39% vs 25%, p<0.01), and Killip class, while left ventricular ejection fraction was similar among patients from the 2 groups. Significantly more patients in the late period underwent PCI compared to the early period (94% vs 55%, p<0.01), received more dual antiplatelet therapy (84% vs 42%, p<0.01), beta blockers (80% vs 67%, p<0.01), angiotensin-converting enzyme inhibitors (74% vs 69%, p<0.02) and statins (91% vs 53%, p<0.01). Hospital duration was significantly higher in patients from early compared to the late period (8±7 vs 7±6 days, p<0.01). In-hospital, 7-day-, 30-day- and 1-year mortality rate were significantly higher in octogenarians from the early compared to the late period (12% vs 8%, p<0.02; 11% vs 8%, p<0.05; 17% vs 14%, p<0.07; 32% vs 27%, p<0.05; respectively). Major adverse CV events (30-day mortality, hospitalization for unstable angina, MI) were also significantly more frequent in those from the early compared to the late group (31% vs 21%, p<0.01). Multivariate Cox regression analysis demonstrated better 1-year survival in octogenarians from the late compared to the early period [HR 1.17, 95% CI 0.87-1.57 (p=0.03)] (Figure).
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Conclusion: In-hospital, 30-day and 1-year survival rates of ACS octogenarians in Israel during the period 2008 to 2013 significantly improved compared to those in the earlier period between year 2000 to 2006.
