Causes of Death in Patients ¡Ý75 Years of Age With Non-ST-Segment Elevation Acute Coronary Syndrome

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• 作者：Nuccia Morici ; MD^a ; Stefano Savonitto ; MD^b ; ^{stefano.savonitto@asmn.re.it} ; Ernesto Murena ; MD^c ; Roberto Antonicelli ; MD^d ; Giancarlo Piovaccari ; MD^e ; Daniele Tucci ; MD^f ; Corrado Tamburino ; MD^g ; Alessandro Fontanelli ; MD^h ; Leonardo Bolognese ; MDⁱ ; Mila Menozzi ; MD^b ; Claudio Cavallini ; MD^j ; Anna Sonia Petronio ; MD^k ; Giuseppe Ambrosio ; MD^l ; Federico Piscione ; MD^m ; Giuseppe Steffenino ; MDⁿ ; Stefano De Servi ; MD^o
• 刊名：The American Journal of Cardiology
• 出版年：2013
• 出版时间：1 July, 2013
• 年：2013
• 卷：112
• 期：1
• 页码：1-7
• 全文大小：232 K

文摘

The causes of death within 1 year of hospital admission in patients with non-ST-segment elevation acute coronary syndromes are ill defined, particularly in patients aged ¡Ý75 years. From January 2008 through May 2010, we enrolled 645 patients aged ¡Ý75 years with non-ST-segment elevation acute coronary syndromes: 313 in a randomized trial comparing an early aggressive versus an initially conservative approach, and 332, excluded from the trial for specific reasons, in a parallel registry. Each death occurring during 1 year of follow-up was adjudicated by an independent committee. The mean age was 82 years in both study cohorts, and 53 % were men. By the end of the follow-up period (median 369 days, interquartile range 345 to 391), 120 patients (18.6 % ) had died. The mortality was significantly greater in the registry (23.8 % vs 13.1 % , p?= 0.001). The deaths were classified as cardiac in 94 % of the cases during the index admission and 68 % of the cases during the follow-up period. Eighty-six percent of the cardiac deaths were of ischemic origin. In a multivariate logistic regression model that included the variables present on admission in the whole study population, the ejection fraction (hazard ratio 0.95, 95 % confidence interval 0.94 to 0.97; p <0.001), hemoglobin level (hazard ratio 0.85, 95 % confidence interval 0.76 to 0.94; p?= 0.001), older age (hazard ratio 1.05, 95 % confidence interval 1.01 to 1.10, p?= 0.010), and creatinine clearance (hazard ratio 0.99, 95 % confidence interval 0.97 to 0.99; p?= 0.030) were the independent predictors of all-cause death at 1 year. In conclusion, within 1 year after admission for non-ST-segment elevation acute coronary syndromes, most deaths in patients aged ¡Ý75 years have a cardiac origin, mostly owing to myocardial ischemia.