The Efficacy and Safety of Evaluating Elderly Patients Using an Accelerated Diagnostic Protocol via a Chest Pain Unit (PLATIS-8)

Roy Beigel 1,2 Moran Livne 1,2 Avi Sabbag 1,2 Elad Maor 1,2 Orly Goitein 1,2 Ronen Goldkorn 1,2 Alex Fardman 1,2 Elad Asher 1,2 Shlomi Matetzky 1,2
1Leviev Heart Institute, Sheba Medical Center and Tel Aviv University, Tel-Hashomer, Israel
2Sackler school of medicine, Tel Aviv University, Israel

 

Background: An accelerated diagnostic protocol (ADP) for evaluating patients with acute chest pain using a chest pain unit (CPU) has shown its safety and cost-effectiveness. Nevertheless, elderly patients are often excluded from such a rapid evaluation due to fear from adverse events and poorer outcome.

 

Objective: To assess the feasibility and safety of evaluation of patients ≥ 65 years old presenting with ACP using an ADP using contemporary noninvasive imaging modalities.

 

Methods: We evaluated 1,068 consecutive patients who were admitted to our CPU and underwent evaluation using either multi-detector computed tomography (MDCT) or myocardial perfusion imaging (MPI).Patients were evaluated for in hospital outcomes and 90 days MACE consistent of recurrent hospitalization due to chest pain, PCI, re-ACS, and death.

 

Results: Overall, 180 patients comprised the group ≥65 years old. Patients ≥65 were significantly more likely to be female, have more co-morbidity and have a history of ACS. There was no difference between the 2 groups during the observation period in the CPU in regard to recurrent chest pain, abnormal ECG findings, and troponin elevation. Patients ≥65 years old underwent significantly more MPI tests (67% vs. 39%,p

 

Conclusion: Evaluation of elderly patient s through a CPU is feasible with comparable in hospital outcomes to younger individuals. While elderly patients should not be excluded from being evaluated through a CPU, these patients suffer a higher event rate during follow-up.









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