Journal of the Indian Academy of Geriatrics (Jan 2020)

The clinical and coronary angiographic profile of 601 older adult patients with acute coronary syndrome treated at a tertiary hospital in North India and complications of percutaneous coronary intervention with the 30-day mortality

  • Umar H Khan,
  • Murtaza R Pala,
  • Imran Hafeez,
  • Afshan Shabir,
  • Aamir Rashid,
  • Nisar Tramboo,
  • Hilal Rather

DOI
https://doi.org/10.4103/jiag.jiag_10_20
Journal volume & issue
Vol. 16, no. 4
pp. 139 – 144

Abstract

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Aims: The aim is to identify clinical and coronary angiographic (CAG) profile of older adult patients with the acute coronary syndrome (ACS), assess complications of percutaneous coronary intervention (PCI) and the 30-day mortality. Materials and Methods: This was a prospective observational study of 601 older adult patients with ACS who underwent CAG over 2 years (2017–2019). The study population was divided into two groups: the young, old group (60–70-year-old), and the old group (>70-year-old). Results: Mean age of presentation was 77 ± 17 years. The majority were males 486 (80.9%). Presenting symptoms was chest pain (94.8%), followed by diaphoresis (33%) and dyspnea (27.4%). ST-elevation myocardial infarction (STEMI) was seen in 377 (62.7%) of the study population, followed by non-STEMI 176 (29.2%) and unstable angina (UA) in 48 (7.9%) patients. Hypertension was the most prevalent risk factor (78%) in the study population. The left anterior descending artery (LAD) was most commonly involved vessel in 415 patients (69.1%) followed by right coronary artery 322 (53.6%) and left circumflex artery 240 (39.9%). Contrast nephropathy (contrast-induced nephropathy [CIN]) occurred in 3.3%, and intra cerebral hemorrhage (ICH) was seen in one patient only. The 30-day mortality was 2.7% in 60–70 years and 14.1% in >70 years. Conclusion: Older patients with ACS differ from their younger counterparts in their clinical presentation, comorbidities, and outcome. Elderly patients can present with atypical symptoms. The 30-day mortality was higher in patients presenting with atypical symptoms, which was statistically significant in multivariate analysis. Like their younger counterparts, most older ACS patients had single-vessel disease, and the most common vessel involved was the LAD. Overall mortality was 5.3%. Even though elderly patients have a high coronary risk because of associated comorbidities, this study proves that PCI's CAG (if indicated) resulted in fewer CIN and ICH complications in older patients with ACS.

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