- 作者：Iñ ; aki ; Villanueva-Benito ; ; ; ivillanu@hotmail.com ; ; inaki.villanuevabenito@osakidetza.es ; Itziar ; Solla-Ruí ; z ; Emilio ; Paredes-Galá ; n ; Ó ; scar ; Dí ; az-Castro ; Francisco E. ; Calvo-Iglesias ; Jose A. ; Baz-Alonso ; André ; s ; Í ; ñ ; iguez-Romo
- 关键词：Acute Coronary Syndrome ; Coronary artery disease ; Coronary angiography ; Interventional cardiology ; The Elderly ; Geriatric medicine ; Prognosis ; Survival
- 刊名：Revista Española de Cardiología (English Edition)
- 出版年：2011
- 出版时间：October 2011
- 年：2011
- 卷：64
- 期：10
- 页码：853-861
- 全文大小：286 K
Introduction and objectives
In moderate or high risk non-ST segment elevation acute coronary syndrome, clinical practice guidelines recommend a coronary angiography with intent to revascularize. However, evidence to support this recommendation in very elderly patients is poor.Methods
All patients over 85 years old admitted to our hospital between 2004 and 2009 with a diagnosis of non-ST segment elevation acute coronary syndrome were retrospectively included. Using a propensity score, patients undergoing the interventional approach and those undergoing conservative management were matched and compared for survival and survival without ischemic events.
Results
We included 228 consecutive patients with a mean age of 88 years (range: 85 to 101). Those in the interventional approach group (n = 100) were younger, with a higher proportion of males and less comorbidity, less cognitive impairment and lower troponin I levels compared with patients in the conservative management group (n = 128). We matched 63 patients from the interventional approach group and 63 from the conservative management group using propensity score.
In the matched patients, the interventional approach group exhibited better survival (log rank 4.24; P = .039) and better survival free of ischemic events (log rank 8.63; P = .003) at the 3-year follow-up. In the whole population, adjusted for propensity score quintiles, the interventional approach group had lower mortality (hazard ratio 0.52; 95 % confidence interval: 0.32-0.85) and a better survival free of ischemic events (hazard ratio 0.48; 95 % confidence interval: 0.32-0.74).
Conclusions
Nearly all the very elderly patients admitted with non-ST segment elevation acute coronary syndrome were of moderate or high risk. In these patients, the interventional approach was associated with overall better survival and better survival free of ischemic events.