Clinical outcome of older patients with acute coronary syndrome over the last three decades
Dunedin Public Hospital, Cardiology, Dunedin, Otago, and Dunedin School of Medicine, University of Otego, New Zealand.
* Address correspondence to: C.-K. Wong, Associate Professor in Cardiology. Email: cheuk-kit.wong{at}healthotago.co.nz
Objective: to evaluate the clinical outcome of patients with acute coronary syndrome (ACS) in the Coronary Care Unit (CCU) over three decades in Dunedin, New Zealand.
Design: registry study.
Setting and patients: all consecutive patients (n = 3,013) with ACS admitted to the CCU from 1979 to 1981 (n = 966) and from 1989 to 1991 (n = 1470) were included prospectively. Data on ACS patients managed in the CCU in 2001–2002 (n = 577) were obtained via medical chart review.
Results: there was a rising proportion of older (
75 years of age) patients with ACS (3.8% in 1979–1981, 15.2% in 1989–1991 and 25.6% in 2001–2002, P<0.0005). However, we observed a progressive reduction of in-hospital mortality for ACS (10.7, 7.3 and 5.0%, P<0.005) and for ST-elevation myocardial infarction (STEMI) (18.4, 16.1 and 6.6%, P<0.005). The progressive fall in mortality rate was also observed amongst older patients, both for ACS (27, 19.2 and 11.5%, P = 0.011) and for STEMI (34.8, 30.9 and 15.4%, P<0.005). Of concern, only 10% of patients presented within 1 h of symptom onset and 50% within 5 h, and this has not changed over three decades. The variables associated with <5 h from symptom onset to presentation were men [odds ratio (OR) 1.25, 95% confidence interval (CI) 1.10–1.42, P = 0.001], a history of ischaemic heart disease (OR 1.25, 95% CI 1.09–1.43, P = 0.002) and STEMI (OR 1.41, 95% CI 1.18–1.67, P<0.0001). Advanced age was not a predictor for late presentation.
Conclusions: over the past three decades, more old patients were treated in the CCU. However, there was a decline in hospital mortality, particularly for STEMI. Further efforts are required to decrease the time to presentation.
Keywords: acute coronary syndrome, changing demography, cardiovascular outcome, elderly
Received July 7, 2005; accepted in revised form February 9, 2006.
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