Temporal trends in the treatment and outcomes of elderly patients with acute coronary syndrome
Andreas W Schoenenberger, Dragana Radovanovic, Stephan Windecker, Juan F Iglesias, Giovanni Pedrazzini, Andreas E Stuck, Paul Erne, AMIS Plus Investigators, P Lessing, F Hess, R Simon, Pj Hangartner, U Hufschmid, B Hornig, R Jeger, S Trummler, S Windecker, T Rueff, P Loretan, C Roethlisberger, D Evéquoz, G Mang, D Ryser, R Jecker, W Kistler, A Droll, S Stäuble, G Freiwald, Hp Schmid, Jc Stauffer, S Cook, K Bietenhard, M Roffi, W Wojtyna, R Schönenberger, R Waldburger, M Schmidli, B Federspiel, Em Weiss, K Weber, H Zender, I Poepping, A Hugi, E Koltai, G Pedrazzini, P Erne, F Cuculi, T Heimes, A Pagnamenta, P Urban, C Stettler, F Repond, F Widmer, C Heimgartner, R Polikar, S Bassetti, Hu Iselin, M Giger, P Egger, T Kaeslin, A Fischer, T Herren, P Eichhorn, C Neumeier, G Flury, G Girod, R Vogel, B Niggli, H Rickli, S Yoon, J Nossen, U Stoller, E Bächli, A Weber, D Schmidt, J Hellermann, U Eriksson, T Fischer, M Peter, S Gasser, R Fatio, M Vogt, D Ramsay, O Bertel, M Maggiorini, F Eberli, S Christen, Andreas W Schoenenberger, Dragana Radovanovic, Stephan Windecker, Juan F Iglesias, Giovanni Pedrazzini, Andreas E Stuck, Paul Erne, AMIS Plus Investigators, P Lessing, F Hess, R Simon, Pj Hangartner, U Hufschmid, B Hornig, R Jeger, S Trummler, S Windecker, T Rueff, P Loretan, C Roethlisberger, D Evéquoz, G Mang, D Ryser, R Jecker, W Kistler, A Droll, S Stäuble, G Freiwald, Hp Schmid, Jc Stauffer, S Cook, K Bietenhard, M Roffi, W Wojtyna, R Schönenberger, R Waldburger, M Schmidli, B Federspiel, Em Weiss, K Weber, H Zender, I Poepping, A Hugi, E Koltai, G Pedrazzini, P Erne, F Cuculi, T Heimes, A Pagnamenta, P Urban, C Stettler, F Repond, F Widmer, C Heimgartner, R Polikar, S Bassetti, Hu Iselin, M Giger, P Egger, T Kaeslin, A Fischer, T Herren, P Eichhorn, C Neumeier, G Flury, G Girod, R Vogel, B Niggli, H Rickli, S Yoon, J Nossen, U Stoller, E Bächli, A Weber, D Schmidt, J Hellermann, U Eriksson, T Fischer, M Peter, S Gasser, R Fatio, M Vogt, D Ramsay, O Bertel, M Maggiorini, F Eberli, S Christen
Abstract
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.
Keywords: Aged 80 and over; Cohort studies; Coronary angiography; Elderly; Myocardial ischaemia.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.
Source: PubMed