0464: Impact of invasive strategy in elderly patients referred for acute coronary syndrome

BackgroundLimited data are available in elderly patients admitted for acute coronary syndromes (ACS). The purpose of this study is to assess the beneficial impact of aggressive treatment strategy (i.e. coronary angiogram and revascularization) on outcome in elderly patients.MethodAmong 1702 patients admitted for ACS, 294 patients were ≥80 years old. ACS was defined as chest pain associated with either troponin rise or new change in ST segment or T wave. Patients with STEMI were excluded and 235 patients (85±3 years old, 125 men) were analyzed. We compared outcome (death and emergency readmission) according to treatment strategy (conservative or invasive)ResultsCoronary angiography was performed in 146 patients while 88 received medical treatment alone. Patients with angiography performed were younger (84.5±3.2 years vs. 85.6±3.9 years) but had similar event risk (GRACE score 174±26 vs. 179±33). During follow up (median=498 days), one year mortality and emergency readmission was similar regardless the decision to perform angiogram (41.2% vs. 43.6%, p=0.7) but in hospital stay was longer when angiogram was performed (4.1±3.7 vs. 2.9±2.8, p=0.01). Among the 146 patients who underwent angiography, revascularization was performed in 98. Age did not influence revascularization but Grace score did (177±26 vs. 167±30). Importantly, only patients with Left main (LM) or proximal LAD disease benefited from revascularization (1-year free event survival 26% vs. 79%, p=0.0003) whereas patients without did not (39% vs. 35%, p=0.7). Kaplan Meier analysis of outcome during follow up confirmed that patients with non revascularized LM or proximal LAD disease had worth outcome (LogRank p=0.009)ConclusionInvasive management of ACS in elderly patients improves survival in patients with LM or proximal LAD disease. In other patients, it only prolongs in-hospital stay. Upstream stratification may be useful to identify patients with suspected LM or proximal LAD disease