Emergency coronary angiography in a 90-plus population: outcomes at 5-year follow-up

Submitted: January 14, 2023
Accepted: February 13, 2023
Published: February 21, 2023
Abstract Views: 900
PDF: 203
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Authors

Elderly people represent a vulnerable and increasing population presenting with acute coronary syndrome (ACS). Our goal was to evaluate a group of very old patients who underwent emergency coronary angiography (CA). We retrospectively analyzed a group of very old patients (≥90 years old) who underwent emergency CA from 2008 to 2020. Survival and major adverse cardiovascular events (MACE) (a composite of all-cause death, ischemic stroke, ACS, or hospitalization for acute heart failure) were compared with an aged-matched control population with ACS not submitted to emergency CA. A total of 34 patients were enrolled, 56% of whom were female, with a median age of 92 years old. Almost all patients had ST elevation-ACS. In CA, 65% had multivessel disease, and coronary intervention was performed in 71%. More than one-third evolved in Killip class III/IV, and 70% had left ventricular dysfunction. Regarding mortality, 38% of patients died in the index event versus 25% in the aged-matched control group (p=0.319). During 5 years of follow-up, there was no significant difference in mortality between the 2 groups (Log-rank=0.403) and more than 50% of patients died in 2 years. Comparing MACE occurrence, both groups were similar (Log-rank=0.662), with more than 80% having at least one event in 5 years. Very old patients submitted to emergency CA had a high rate of multivessel disease and left ventricular dysfunction, in-hospital and follow-up mortality, and MACE. Compared to an aged-matched control group not submitted to emergency CA, they showed no survival or MACE benefit during a 5-year follow-up.

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Citations

World Health Organization. Global health estimates: life expectancy and leading causes of death and disability. Available from: https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates.
Collet JP, Thiele H, Barbato E, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021;42:1289-367.
Morici N, De Servi S, De Luca L, et al. Management of acute coronary syndromes in older adults. Eur Heart J 2022;43:1542-53.
Tahhan AS, Vaduganathan M, Greene SJ, et al. Enrollment of older patients, women, and racial/ethnic minority groups in contemporary acute coronary syndrome clinical trials: a systematic review. JAMA Cardiol 2020;5:714-22.
van Wyk GW, Berkovsky S, Navarro DF, Coiera E. Comparing health outcomes between coronary interventions in frail patients aged 75 years or older with acute coronary syndrome: a systematic review. Eur Geriatr Med 2022;13:1057-69.
Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI guideline for Coronary artery revascularization: a report of the American College of cardiology/American Heart Association Joint Committee on clinical practice guidelines. J Am Coll Cardiol 2022;79:e21-129.
Bamford JM, Sandercock PAG, Wariow CP, Slattery J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1989;20:828.
Leonardi S, Bueno H, Ahrens I, et al. Optimised care of elderly patients with acute coronary syndrome. Eur Hear J Acute Cardiovasc Care 2018;7:287-95.
Tegn N, Abdelnoor M, Aaberge L, et al. Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (after eighty study): an open-label randomised controlled trial. Lancet 2016;387:1057-65.
Batchelor WB, Anstrom KJ, Muhlbaier LH, et al. Contemporary outcome trends in the elderly undergoing percutaneous coronary interventions: results in 7,472 octogenarians. J Am Coll Cardiol 2000;36:723-30.
Wang TY, Gutierrez A, Peterson ED. Percutaneous coronary intervention in the elderly. Nat Rev Cardiol 2011;8:79-90.
Gimbel M, Qaderdan K, Willemsen L, et al. Clopidogrel versus ticagrelor or prasugrel in patients aged 70 years or older with non-ST-elevation acute coronary syndrome (POPular AGE): the randomised, open-label, non-inferiority trial. Lancet 2020;395:1374-81.

Ethics Approval

This study was approved by the institutional ethics committee.

How to Cite

Proença, Tânia, Ricardo Alves Pinto, Miguel Martins Carvalho, Paula Dias, and Filipe Macedo. 2023. “Emergency Coronary Angiography in a 90-Plus Population: Outcomes at 5-Year Follow-up”. Monaldi Archives for Chest Disease 94 (1). https://doi.org/10.4081/monaldi.2023.2526.