Causes of death in patients ≥75 years of age with non-ST-segment elevation acute coronary syndrome.

First Division of Cardiology, Dipartimento Cardio-toraco-vascolare A. De Gasperis, Azienda Ospedaliera Ospedale Niguarda Cà Granda, Milan, Italy.

The American journal of cardiology 2013 Jul 1

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The causes of death within 1 year of hospital admission in patients with non-ST-segment elevation acute coronary syndromes are ill defined, particularly in patients aged ≥75 years. From January 2008 through May 2010, we enrolled 645 patients aged ≥75 years with non-ST-segment elevation acute coronary syndromes: 313 in a randomized trial comparing an early aggressive versus an initially conservative approach, and 332, excluded from the trial for specific reasons, in a parallel registry. Each death occurring during 1 year of follow-up was adjudicated by an independent committee. The mean age was 82 years in both study cohorts, and 53% were men. By the end of the follow-up period (median 369 days, interquartile range 345 to 391), 120 patients (18.6%) had died. The mortality was significantly greater in the registry (23.8% vs 13.1%, p = 0.001). The deaths were classified as cardiac in 94% of the cases during the index admission and 68% of the cases during the follow-up period. Eighty-six percent of the cardiac deaths were of ischemic origin. In a multivariate logistic regression model that included the variables present on admission in the whole study population, the ejection fraction (hazard ratio 0.95, 95% confidence interval 0.94 to 0.97; p <0.001), hemoglobin level (hazard ratio 0.85, 95% confidence interval 0.76 to 0.94; p = 0.001), older age (hazard ratio 1.05, 95% confidence interval 1.01 to 1.10, p = 0.010), and creatinine clearance (hazard ratio 0.99, 95% confidence interval 0.97 to 0.99; p = 0.030) were the independent predictors of all-cause death at 1 year. In conclusion, within 1 year after admission for non-ST-segment elevation acute coronary syndromes, most deaths in patients aged ≥75 years have a cardiac origin, mostly owing to myocardial ischemia. Copyright © 2013 Elsevier Inc. All rights reserved.

Citation

Nuccia Morici, Stefano Savonitto, Ernesto Murena, Roberto Antonicelli, Giancarlo Piovaccari, Daniele Tucci, Corrado Tamburino, Alessandro Fontanelli, Leonardo Bolognese, Mila Menozzi, Claudio Cavallini, Anna Sonia Petronio, Giuseppe Ambrosio, Federico Piscione, Giuseppe Steffenino, Stefano De Servi. Causes of death in patients ≥75 years of age with non-ST-segment elevation acute coronary syndrome. The American journal of cardiology. 2013 Jul 1;112(1):1-7