Article Text

The impact of increased age on outcome from a strategy of early invasive management and revascularisation in patients with acute coronary syndromes: retrospective analysis study from the ACACIA registry
  1. Christopher J Malkin1,
  2. Roshan Prakash2,
  3. Derek P Chew2
  1. 1Leeds General Infirmary, The Yorkshire Heart Centre, Leeds, West Yorkshire, UK
  2. 2Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
  1. Correspondence to Dr Christopher Malkin; chrismalkin{at}gmail.com

Abstract

Objective To evaluate the impact of increased age on outcome from a strategy of early invasive management and revascularisation in patients with acute coronary syndromes (ACS).

Design Retrospective analysis of a national Acute Coronary Syndrome registry (ACACIA).

Setting Multiple Australian (n=39) centres; 25% rural, 52% with onsite cardiac surgery.

Patients Unselected consecutive patients admitted with confirmed ACS, total n=2559, median 99 per centre.

Interventions Management was at the discretion of the treating physician. Analysis of outcome based on age >75 years was compared using Cox proportional hazard with a propensity model to adjust for baseline covariates.

Main outcome measures Primary outcome was all-cause mortality. Secondary outcomes were bleeding and a composite of any vascular event or unplanned readmission.

Results Elderly patients were more likely to present with high-risk features yet were less likely to receive evidence-based medical therapies or receive diagnostic coronary angiography (75% vs 49%, p<0.0001) and early revascularisation (50% vs 30%, p<0.0001). Multivariate analysis found early revascularisation in the elderly cohort to be associated with lower 12-month mortality hazard (0.4 (0.2–0.7)) and composite outcome (0.6 (0.5–0.8)). Propensity model suggested a greater absolute benefit in elderly patients compared to others.

Conclusions Following presentation with ACS, elderly patients are less likely to receive evidence-based medical therapies, to be considered for an early invasive strategy and be revascularised. Increasing age is a significant barrier to physicians when considering early revascularisation. An early invasive strategy with revascularisation when performed was associated with substantial benefit and the absolute accrued benefit appears to be higher in elderly patients.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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Footnotes

  • To cite: Malki CJ, Prakash R, Chew DP. The impact of increased age on outcome from a strategy of early invasive management and revascularisation in patients with acute coronary syndromes: retrospective analysis study from the ACACIA registry. BMJ Open 2012;2:e000540. doi:10.1136/bmjopen-2011-000540

  • Contributors CM analysed the data and wrote the first draft of the manuscript. RP helped analyse the data and edited the final draft of the manuscript. DPC developed the initial concept and supervised analysis and editing of the final draft of the paper. DPC is the guarantor of this submission.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None.

  • Patient consent Patients in this registry signed standard consent forms approved by the Flinders Medical Centre ethics committee in South Australia.

  • Ethics approval Flinders Medical Centre Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The original ACACIA data can be requested by permission from DPC, Flinders Medical Centre, Adelaide, South Australia.

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