Author + information
- Received July 14, 2006
- Revision received January 5, 2007
- Accepted January 5, 2007
- Published online May 1, 2007.
- Adam H. Skolnick, MD⁎,
- Karen P. Alexander, MD†,
- Anita Y. Chen, MS†,
- Matthew T. Roe, MD, MSH†,
- Charles V. Pollack Jr, MD, MA‡,
- E. Magnus Ohman, MD†,
- John S. Rumsfeld, MD, PhD§,
- W. Brian Gibler, MD∥,
- Eric D. Peterson, MD, MPH† and
- David J. Cohen, MD, MSc⁎,¶,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. David J. Cohen, Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, Kansas City, Missouri 64111.
Objectives The goal of this work was to explore the treatment and outcomes of patients with non–ST-segment elevation acute coronary syndromes (NSTE-ACS) age ≥90 years.
Background The elderly are often excluded from clinical trials of NSTE-ACS and are underrepresented in clinical registries.
Methods We used data from the CRUSADE registry to study 5,557 patients with NSTE-ACS age ≥90 years and compared their baseline characteristics, treatment patterns, and in-hospital outcomes with a cohort age 75 to 89 years (n = 46,270).
Results Although both groups had much in common, compared with the younger elderly, the older elderly were less likely to be diabetic, smokers, or obese. Among patients without contraindications, the older elderly were less likely to receive glycoprotein IIb/IIIa inhibitors and statins during the first 24 h and were less likely to undergo cardiac catheterization within 48 h. The older elderly were more likely to die (12.0% vs. 7.8%) and experienced more frequent adverse events (26.8% vs. 21.3%) during the hospitalization—differences that persisted after adjustment for baseline patient and hospital characteristics. Increasing adherence to guideline-recommended therapies was associated with both increased bleeding and a graded reduction in risk-adjusted in-hospital mortality across both age groups.
Conclusions In this large population of nonagenarians and centenarians with NSTE-ACS, increasing adherence to guideline-recommended therapies was associated with decreased mortality. These findings reinforce the importance of optimizing care patterns for even the oldest patients with NSTE-ACS, while examining novel approaches to reduce the risk of bleeding in this rapidly expanding patient population.
CRUSADE is a National Quality Improvement Initiative of the Duke Clinical Research Institute. CRUSADE is funded by the Schering-Plough Corporation (Kenilworth, New Jersey). Bristol-Myers Squibb (New York, New York)/Sanofi (Bridgewater, New Jersey) Pharmaceuticals Partnership provided additional funding support. Millennium Pharmaceuticals, Inc. (Cambridge, Massachusetts) also funded this work.
- Received July 14, 2006.
- Revision received January 5, 2007.
- Accepted January 5, 2007.
- American College of Cardiology Foundation