Background: ACS is a leading cause of mortality worldwide, but it is unknown whether the advanced age of patients constitutes a prognostic factor. Objective: The present study compared the burden of risk factors and the prognosis of ACS in older and younger patients in order to improve their management. Methods. A retrospective analysis of a series of ACS patients admitted from January to December 2022 to intensive care unit of the cardiology department at the South Francilian Hospital Center. Results: The files of 551 patients including 60 elderly subjects (10.9%) were analyzed. Average age was 81.7 ± 6.1 years for the elderly, 54.5 ± 11.9 years for the younger patients. Men predominated in both age categories (p = 0.014) and were older than women (59.2 ± 14.3 vs 53.1 ± 13.2 years; p = 0.014). Obesity (p = 0.007), smoking (p = 0.002) and dyslipidemia (p = 0.022) were the cardiovascular risk factors found more in elderly patients, hypertension (p < 0.001) and diabetes (p < 0.001) in the youngest. NSTEMI (66.3%) predominated in both the elderly (55.0%) and the younger (60.8%) subjects. Treatment consisted of immediate angioplasty in 66.1%, including 61.7% elderly subjects and 66.6% younger subjects (p = 0.224). Death was significantly associated with the severity of coronary lesions (p < 0.001) and chronic renal failure (p = 0.006), with no significant influence of age. Conclusion: The proportion of elderly subjects with ACS is not negligible. Comorbidities increase the prognosis, without age per se being associated with death.
References
[1]
Roth, G.A., Mensah, G.A., Johnson, C.O., Addolorato, G., Ammirati, E., Baddour, L.M., et al. (2020) Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019. JournaloftheAmericanCollegeofCardiology, 76, 2982-3021. https://doi.org/10.1016/j.jacc.2020.11.010
[2]
Roth, G.A., Abate, D., Abate, K.H., Abay, S.M., Abbafati, C., Abbasi, N., et al. (2018) Global, Regional, and National Age-Sex-Specific Mortality for 282 Causes of Death in 195 Countries and Territories, 1980-2017: A Systematic Analysis for the Global Burden of Disease Study 2017. TheLancet, 392, 1736-1788. https://doi.org/10.1016/s0140-6736(18)32203-7
[3]
Byrne, R.A., Rossello, X., Coughlan, J.J., Barbato, E., Berry, C., Chieffo, A., et al. (2023) 2023 ESC Guidelines for the Management of Acute Coronary Syndromes. EuropeanHeartJournal, 44, 3720-3826. https://doi.org/10.1093/eurheartj/ehad191
[4]
Akoudad, H. and Benamer, H. (2004) Physiopathologie et étiopathogénie de l’infarctus du myocarde. EMC—Cardiologie-Angéiologie, 1, 49-67. https://doi.org/10.1016/j.emcaa.2003.12.003
[5]
Ratcovich, H., et al. (2024) Prevalence and Impact of Frailty in Patients ≥ 70 Years Old with Acute Coronary Syndrome Referred for Coronary Angiography. https://karger.com/crd/article-pdf/149/1/1/4164382/000535116.pdf
[6]
Chenu, P.C. (2024) Quel type de revascularisation coronaire chez le patient de plus de 80 ans ? https://www.louvainmedical.be/sites/default/files/content/article/pdf/lmed-12-2016-08-chenu.pdf
[7]
Bianco, M., Mottola, F.F., Cerrato, E., Giordana, F., Cinconze, S., Baralis, G., et al. (2023) Acute Coronary Syndrome in Very Elderly Patients—A Real-World Experience. HeartandVessels, 38, 1019-1027. https://doi.org/10.1007/s00380-023-02260-x
[8]
Ibanez, B., James, S., Agewall, S., Antunes, M.J., Bucciarelli-Ducci, C., Bueno, H., et al. (2017) 2017 ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting with St-Segment Elevation. EuropeanHeartJournal, 39, 119-177. https://doi.org/10.1093/eurheartj/ehx393
[9]
Murray, C.J. and Lopez, A.D. (1997) Alternative Projections of Mortality and Disability by Cause 1990–2020: Global Burden of Disease Study. TheLancet, 349, 1498-1504. https://doi.org/10.1016/s0140-6736(96)07492-2
[10]
Gondele, D.I., Kintoki, E.V., Lubenga, Y., Ngoyi, G., Mvunzi, T., Mupepe, D., et al. (2023) A Pilot Study about the First Cases of Coronary Angioplasty in Democratic Republic of Congo/kinshasa: Patient Profile. CaseReportsinClinicalMedicine, 12, 371-388. https://doi.org/10.4236/crcm.2023.1210052
[11]
Bouisset, F., Huo, S., Kai, Y. et al. (2021) Pronostic à Court et Long Terme des Syndromes Coronariens Aigus avec et sans Sus-Décalage du Segment ST chez les Sujets Âgés de 35 à 74 Ans dans Trois Zones Françaises: Résultats du Registre Populationnel MONICA. Bull EpidémiolHebd, 15, 266-274.
[12]
Mavungu Mbuku, J., Mukombola Kasongo, A., Goube, P., Miltoni, L., Nkodila Natuhoyila, A., M’Buyamba-Kabangu, J., et al. (2023) Factors Associated with Complications in ST-Elevation Myocardial Infarction: A Single-Center Experience. BMCCardiovascularDisorders, 23, Article No. 468. https://doi.org/10.1186/s12872-023-03498-z
[13]
Saunderson, C.E.D., Brogan, R.A., Simms, A.D., Sutton, G., Batin, P.D. and Gale, C.P. (2014) Acute Coronary Syndrome Management in Older Adults: Guidelines, Temporal Changes and Challenges. AgeandAgeing, 43, 450-455. https://doi.org/10.1093/ageing/afu034
[14]
Alexander, K.P., Newby, L.K., Armstrong, P.W., Cannon, C.P., Gibler, W.B., Rich, M.W., et al. (2007) Acute Coronary Care in the Elderly, Part II: ST-Segment-Elevation Myocardial Infarction: A Scientific Statement for Healthcare Professionals from the American Heart Association Council on Clinical Cardiology: In Collaboration with the Society of Geriatric Cardiology. Circulation, 115, 2570-2589. https://doi.org/10.1161/circulationaha.107.182616
[15]
Jomaa, W., Hamdi, S., Ben Ali, I., Azaiez, M.A., El Hraiech, A., Ben Hamda, K., et al. (2016) Risk Profile and In-Hospital Prognosis in Elderly Patients Presenting for Acute St-Elevation Myocardial Infarction in the Tunisian Context. Indian Heart Journal, 68, 760-765. https://doi.org/10.1016/j.ihj.2016.01.020
[16]
Puymirat, E., Barbey, C., Chassaing, S., Bar, O. and Blanchard, D. (2010) Dissection iatrogène de la coronaire droite et de l’aorte ascendante au cours d’une procédure d’angioplastie. Annales de Cardiologie et d’Angéiologie, 59, 168-171. https://doi.org/10.1016/j.ancard.2009.05.001
[17]
Barbash, G.I., et al. (1995) Acute Myocardial Infarction in the Young—The Role of Smoking. The Investigators of the International Tissue Plasminogen Activa-tor/Streptokinase Mortality Trial. European Heart Journal, 16, 313-316.
[18]
Ibanez, B., et al. (2018) 2017 ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting with ST-Segment Elevation: The Task Force for the Management of Acute Myocardial Infarction in Patients Presenting with ST-Segment Elevation of the European Society of Cardiology (ESC). European Heart Journal, 39, 119-177.
[19]
Théroux, P., Waters, D., Qiu, S., McCans, J., de Guise, P. and Juneau, M. (1993) Aspirin versus Heparin to Prevent Myocardial Infarction during the Acute Phase of Unstable Angina. Circulation, 88, 2045-2048. https://doi.org/10.1161/01.cir.88.5.2045
[20]
Kastrati, A., Dibra, A., Spaulding, C., Laarman, G.J., Menichelli, M., Valgimigli, M., et al. (2007) Meta-Analysis of Randomized Trials on Drug-Eluting Stents vs. Bare-Metal Stents in Patients with Acute Myocardial Infarction. EuropeanHeartJournal, 28, 2706-2713. https://doi.org/10.1093/eurheartj/ehm402
[21]
Hochman, J.S., Buller, C.E., Sleeper, L.A., Boland, J., Dzavik, V., Sanborn, T.A., et al. (2000) Cardiogenic Shock Complicating Acute Myocardial Infarction—Etiologies, Management and Outcome: A Report from the SHOCK Trial Registry. JournaloftheAmericanCollegeofCardiology, 36, 1063-1070. https://doi.org/10.1016/s0735-1097(00)00879-2
[22]
Collinson, J. (2005) The Management and Investigation of Elderly Patients with Acute Coronary Syndromes without ST Elevation: An Evidence-Based Approach? Results of the Prospective Registry of Acute Ischaemic Syndromes in the United Kingdom (PRAIS-UK). AgeandAgeing, 34, 61-66. https://doi.org/10.1093/ageing/afh236
[23]
Dai, X., Busby-Whitehead, J. and Alexander, K.P. (2016) Acute Coronary Syndrome in the Older Adults. Journal of Geriatric Cardiology, 13, 101-108.
[24]
Mozaffarian, D., Benjamin, E.J., Go, A.S., Arnett, D.K., Blaha, M.J., Cushman, M., et al. (2015) Heart Disease and Stroke Statistics—2015 Update: A Report from the American Heart Association. Circulation, 131, e29-322. https://doi.org/10.1161/cir.0000000000000152
[25]
Morrow, D.A., Antman, E.M., Giugliano, R.P., Cairns, R., Charlesworth, A., Murphy, S.A., et al. (2001) A Simple Risk Index for Rapid Initial Triage of Patients with ST-Elevation Myocardial Infarction: An InTIME II Substudy. TheLancet, 358, 1571-1575. https://doi.org/10.1016/s0140-6736(01)06649-1
[26]
Aragam, K.G., Tamhane, U.U., Kline-Rogers, E., Li, J., Fox, K.A.A., Goodman, S.G., et al. (2009) Does Simplicity Compromise Accuracy in ACS Risk Prediction? A Retrospective Analysis of the TIMI and GRACE Risk Scores. PLOSONE, 4, e7947. https://doi.org/10.1371/journal.pone.0007947
[27]
Granger, C.B. (2003) Predictors of Hospital Mortality in the Global Registry of Acute Coronary Events. ArchivesofInternalMedicine, 163, 2345-2353. https://doi.org/10.1001/archinte.163.19.2345
