SPC365

The 90s are the new 70s: Approach to nonagenarian patients with myocardial infarction: Data from the Real World Registry on Acute Coronary Syndromes

Session: CO 26 - Populações especiais
Speaker: João Grade Santos

Congress: CPC 2021
Topic: K. Cardiovascular Disease In Special Populations
Theme: 30. Cardiovascular Disease in Special Populations
Subtheme: 30.5 Cardiovascular Disease in the Elderly
Session Type: Comunicações Orais
FP Number: ---
Authors: João Grade Santos; Alexandra Briosa; Ana Rita Pereira; Ana Marques; Sofia Alegria; Daniel Sebaiti; Ana Catarina Gomes; Inês Rangel; Gonçalo Morgado; Rita Calé; Cristina Martins; Hélder Pereira; em Nome Dos Investigadores do Registo Nacional de Síndromes Coronários Agudos

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:#222222">Introduction:</span></span></strong><span style="background-color:white"><span style="color:#222222">&nbsp;The approach to Acute Coronary Syndromes is based on robust high quality evidence, currently systematized in European endorsed guidelines. However most trials that support such guidelines excluded or included a small percentage of the very elderly&nbsp;</span></span><span style="color:black">and the clinical decision in this age range is subjected to high interpersonal and inter-hospital variability.</span></span></span></span></p>

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:#222222">Purpose:</span></span></strong><span style="background-color:white"><span style="color:#222222">&nbsp;Our aim was to assess the approach to </span></span><span style="color:black">nonagenarian patients with Acute Coronary Syndromes (ACS), in what regards the choice of percutaneous coronary intervention or conservative management and determine in-hospital and at 1 year outcomes. </span></span></span></span></p>

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:#222222">Methods</span></span></strong><span style="background-color:white"><span style="color:#222222">:&nbsp;We performed a 9 year retrospective analysis of all patients with age equal or greater than ninety (90) admitted with ACS in Portugal. Medical records were analysed for demographic, procedural data and outcomes.</span></span></span></span></span></p>

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:#222222">Results</span></span></strong><span style="background-color:white"><span style="color:#222222">:&nbsp;714 nonagenarian patients were admitted with ACS, which corresponded to 2.4% of the total cohort. The mean age was 92 &plusmn; 2 with a female preponderance (58.7%). There was a high rate of cardiovascular risk factor with hypertension in 81.3%; Dyslipidemia in 46.1% Diabetes Mellitus in 23.4%; and other comorbidities with 21% of prior ACS, 14.4% with Heart Failure and&nbsp;11% with cerebrovascular events.</span></span></span></span></span></p>

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:#222222">The ACS was categorized as ST elevation Myocardial Infarction (STEMI) in 43.9%, non- STEMI (NSTEMI) in 45.8%, and unstable angina (UA) in 2%. </span></span></span></span></span></p>

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:#222222">268 patients,&nbsp;37.8% of the cohort, were submitted to percutaneous coronary intervention (PCI), mainly due to STEMI (68.3%). This cohort were composed of patients with less comorbidities (statistically significant less valvular heart disease, heart failure, peripherical artery disease and dementia although more oncological diseases). There was no difference in the severity of ACS, as categorized by the Kilip Kimbal (KK) classification, mechanical complication or depressed ejection fraction between the 2 groups. (p&gt;0.05 for all)</span></span></span></span></span></p>

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:#222222">There was a statistically significant increase of advanced atrioventricular block (AAB) (10.6 vs 4.4%; p 0.002;</span></span> <span style="background-color:white"><span style="color:black">Logistic regression OR 3.12; IC95 [</span></span><span style="font-family:&quot;Calibri,Bold&quot;,sans-serif"><span style="color:black">1.37-7.15], p 0.007</span></span><span style="background-color:white"><span style="color:#222222">) and major bleeding (1.8 vs 5.5%; p 0.008; </span></span><span style="background-color:white"><span style="color:black">Logistic regression</span></span> <span style="background-color:white"><span style="color:black">OR 3.36; IC95 [</span></span><span style="font-family:&quot;Calibri,Bold&quot;,sans-serif"><span style="color:black">1.36-8.32] p 0.009</span></span> <span style="background-color:white"><span style="color:#222222">) in the PCI group. There was no difference in in-hospital re-infarction, cardiac arrest, stroke or death. (p&gt;0.05 for all)</span></span></span></span></span></p>

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:#222222">The follow up at 1 year was performed in two hundred and fifty-six (256) patients, 30.9% submitted to PCI. </span></span><span style="color:black">Although the survival analysis demonstrated a trend towards improvement in 1-year survival and cardiovascular readmissions in the intervention group, it did not reach statistical significance. </span><span style="background-color:white"><span style="color:#222222">(p&gt;0.05 for all)</span></span></span></span></span></p>

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:#222222">Conclusions</span></span></strong><span style="background-color:white"><span style="color:#222222">:&nbsp;PCI was performed in about a third of nonagenarians presenting with ACS. Our cohort demonstrated a greater rate of in-hospital complications without a significant in-hospital or at 1 year clinical benefit.</span></span></span></span></span></p>