open access

Vol 15, No 5 (2008)
Original articles
Published online: 2008-08-12
Get Citation

In-hospital management and mortality in elderly patients with non-ST-segment elevation acute coronary syndromes treated in centers without on-site invasive facilities

Artur Dziewierz, Zbigniew Siudak, Tomasz Rakowski, Joanna Zdzienicka, Dominika Dykla, Waldemar Mielecki, Jacek S. Dubiel, Dariusz Dudek
Cardiol J 2008;15(5):451-457.

open access

Vol 15, No 5 (2008)
Original articles
Published online: 2008-08-12

Abstract


Background: The purpose was to assess age-related differences in hospital management and mortality in non-ST-elevation acute coronary syndrome (NSTE ACS) patients treated conservatively, with a focus on the influence of aggressive pharmacological treatment on in-hospital clinical outcome.
Methods: We identified 807 NSTE ACS patients treated conservatively in the 29 hospitals participating in the Krakow Registry of Acute Coronary Syndromes from February to March 2005 and from December 2005 to January 2006. Out of 807 patients’ 32.1% were less than 65 years of age, 33% from 65 to 74, 30.5% from 75 to 84, and 5.3% ≥ 85. For all patients, pharmacotherapy index based on the use of pharmacological treatment regimen during hospital stay was assessed. Each patient received 1 point for each of the following guideline-recommended drugs used: aspirin, clopidogrel, glycoprotein IIb/IIIa inhibitor, LMWH, beta-blocker, ACE inhibitor/angiotensin II receptor blocker and statin — the range of points being from 0 to 7.
Results: Significant age-related differences in baseline characteristics and pharmacotherapy index values were found. In-hospital mortality was higher in elderly patients (2.4% vs. 3.4% vs. 8.9% vs. 14.0%, respectively for age groups, p < 0.0001). Similarly, in non-shock patients and in patients with elevated cardiac markers, age-dependent differences in mortality were observed. Independent predictors of in-hospital death were: age, cardiogenic shock, elevated cardiac markers and pharmacotherapy index.
Conclusions: Advanced age is associated with less aggressive pharmacological treatment and higher in-hospital mortality in NSTE ACS patients remaining in community hospitals for conservative treatment. Broader implementation of current guidelines and more frequent invasive treatment might improve the outcomes of NSTE ACS patients regardless of age.

Abstract


Background: The purpose was to assess age-related differences in hospital management and mortality in non-ST-elevation acute coronary syndrome (NSTE ACS) patients treated conservatively, with a focus on the influence of aggressive pharmacological treatment on in-hospital clinical outcome.
Methods: We identified 807 NSTE ACS patients treated conservatively in the 29 hospitals participating in the Krakow Registry of Acute Coronary Syndromes from February to March 2005 and from December 2005 to January 2006. Out of 807 patients’ 32.1% were less than 65 years of age, 33% from 65 to 74, 30.5% from 75 to 84, and 5.3% ≥ 85. For all patients, pharmacotherapy index based on the use of pharmacological treatment regimen during hospital stay was assessed. Each patient received 1 point for each of the following guideline-recommended drugs used: aspirin, clopidogrel, glycoprotein IIb/IIIa inhibitor, LMWH, beta-blocker, ACE inhibitor/angiotensin II receptor blocker and statin — the range of points being from 0 to 7.
Results: Significant age-related differences in baseline characteristics and pharmacotherapy index values were found. In-hospital mortality was higher in elderly patients (2.4% vs. 3.4% vs. 8.9% vs. 14.0%, respectively for age groups, p < 0.0001). Similarly, in non-shock patients and in patients with elevated cardiac markers, age-dependent differences in mortality were observed. Independent predictors of in-hospital death were: age, cardiogenic shock, elevated cardiac markers and pharmacotherapy index.
Conclusions: Advanced age is associated with less aggressive pharmacological treatment and higher in-hospital mortality in NSTE ACS patients remaining in community hospitals for conservative treatment. Broader implementation of current guidelines and more frequent invasive treatment might improve the outcomes of NSTE ACS patients regardless of age.
Get Citation

Keywords

acute coronary syndrome; elderly; management; mortality

About this article
Title

In-hospital management and mortality in elderly patients with non-ST-segment elevation acute coronary syndromes treated in centers without on-site invasive facilities

Journal

Cardiology Journal

Issue

Vol 15, No 5 (2008)

Pages

451-457

Published online

2008-08-12

Bibliographic record

Cardiol J 2008;15(5):451-457.

Keywords

acute coronary syndrome
elderly
management
mortality

Authors

Artur Dziewierz
Zbigniew Siudak
Tomasz Rakowski
Joanna Zdzienicka
Dominika Dykla
Waldemar Mielecki
Jacek S. Dubiel
Dariusz Dudek

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl