Temporal trends in the treatment and outcomes of elderly patients with acute coronary syndrome

European Heart Journal

12 January 2016

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Abstract

AbstractAims

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 (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 (P = 0.020), and in-hospital major adverse cardiac and cerebrovascular events from 14.4 to 11.3% (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, 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, 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.