Temporal trends in the treatment and outcomes of elderly patients with acute coronary syndrome.

Schoenenberger, Andreas; Radovanovic, Dragana; Windecker, Stephan; Iglesias, Juan F; Pedrazzini, Giovanni; Stuck, Andreas; Erne, Paul (2016). Temporal trends in the treatment and outcomes of elderly patients with acute coronary syndrome. European Heart Journal, 37(16), pp. 1304-1311. Oxford University Press 10.1093/eurheartj/ehv698

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AIMS To determine whether treatment and outcomes of older acute coronary syndrome (ACS) patients changed over time. METHODS AND RESULTS We analysed the use of guideline-recommended therapies and in-hospital outcomes of 13 662 ACS patients ≥70 years enrolled in the prospective Acute Myocardial Infarction in Switzerland (AMIS) cohort between 2001 and 2012 according to 4-year periods (2001-2004, 2005-2008, and 2009-2012). Between first and last 4-year period, percutaneous coronary intervention (PCI) use increased from 43.8 to 69.6% of older ACS patients ( ITALIC! P < 0.001). Use of guideline-recommended drugs as well increased. At the same time, in-hospital mortality of the overall population decreased from 11.6% in the first to 10.0% in the last 4-year period ( ITALIC! P = 0.020), and in-hospital major adverse cardiac and cerebrovascular events from 14.4 to 11.3% ( ITALIC! P < 0.001). Percutaneous coronary intervention was used in increasingly older and co-morbid patients over time (mean age of patients treated with PCI 76.2 years in 2001-2004 and 78.1 years in 2009-2012, ITALIC! P < 0.001; Charlson score ≥2 was found for 27.6% of patients treated with PCI in 2001-2004 and for 32.1% in 2009-2012, ITALIC! P = 0.003). Percutaneous coronary intervention use was associated with similar odds ratios (ORs) of in-hospital mortality over time (adjusted OR 0.29, 95% confidence interval, CI, 0.22-0.40, in 2001-2004; and, adjusted OR 0.26, 95% CI 0.20-0.35, in 2009-2012). CONCLUSION Use of guideline-recommended therapies for ACS increased and in-hospital outcomes improved over the observed 12-year period. Though PCI was used in increasingly older and co-morbid patients, PCI use was associated with similar ORs of in-hospital mortality over time. This study suggests that increasing use of guideline-recommended therapies was appropriate. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01305785.

Item Type:

Journal Article (Original Article)

Division/Institute:

?? 31DEB2B84C3766FAE053980C5C8240B8 ??
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Geriatric Clinic > Geriatric Clinic Inselspital
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Schoenenberger, Andreas; Windecker, Stephan and Stuck, Andreas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0195-668X

Publisher:

Oxford University Press

Language:

English

Submitter:

Judith Liniger

Date Deposited:

29 Dec 2016 09:13

Last Modified:

03 Jul 2017 15:23

Publisher DOI:

10.1093/eurheartj/ehv698

PubMed ID:

26757786

Uncontrolled Keywords:

Aged 80 and over; Cohort studies; Coronary angiography; Elderly; Myocardial ischaemia

BORIS DOI:

10.7892/boris.90386

URI:

https://boris.unibe.ch/id/eprint/90386

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