Background: While patients ≥ 80 years old constitute the fastest growing segment of the population and have a high prevalence of coronary artery disease (CAD), few data are available regarding the outcome of octogenarians with acute coronary syndrome (ACS).
Methods: We evaluated in-hospital and 30-day clinical outcome of 13,432 patients [1,731 (13%) ≥ and 11,701 (87%) < 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 two-month periods/year during the period 2000 to 2013.
Results: During the 13 year period of the study the annual hospitalization rate of ACS patients ≥ 80 years (12%) and females (40%) remained steady and unchanged. ACS patients ≥ 80 years (mean age 85±4) had a higher incidence of CAD risk factors, prior cardio-cerebrovascular events, chronic renal failure and cardiac medication use compared to patients < 80 years (mean age 61±11). Time from onset of chest pain to hospitalization and to myocardial infarction (MI) were similar in both groups. Killip class on admission was higher, while left ventricular ejection fraction was lower in ACS ≥ compared to < 80 years. ST elevation MI (STEMI) on admission was more common in ACS patients < than ≥ 80 years (41% vs 31%). In-hospital and 30-day mortality rates were significantly lower in patients ≥ 80 years who underwent, compared with those who did not undergo primary percutaneous coronary interventions (PCI). There was a significant increase in the use of PCI over time among ACS patients ≥ 80 years (19% vs. 57%, p<0.001; respectively). Furthermore, in-hospital (15.6% vs. 6.4%, p<0.05) and 30-day (23.7% vs. 9.7%, p<0.05) mortality rates were significantly reduced. While the absolute reduction in 30-day mortality in patients < 80 years between 2000 and 2013 was 2%, and statistically significant, the 30-day mortality in those ≥ 80 years was significantly higher and reached 14% (p<0.02).
Conclusion: Between 2000 and 2013, the annual hospitalization rate for the diagnosis of ACS among patients ≥ 80 years has not changed over time. Although there was a significant in-hospital and 30-day mortality reduction over time in ACS patients in Israel, the absolute percent reduction in 30-day mortality was significantly higher in octogenarian ACS patients compared to those < 80 years.
