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Title: Impact of age on management and outcome of acute coronary syndrome: Observations from the Global Registry of Acute Coronary Events (GRACE)
Authors: Avezum, A.
Makdisse, M.
Spencer, F.
Gore, J. M.
Fox, KAA
Montalescot, G.
Eagle, K. A.
White, K.
Mehta, R. H.
Knobel, E.
Collet, J. P.
GRACCE Investigators
Dante Pazzanese Cardiol Inst
Universidade Federal de São Paulo (UNIFESP)
Univ Massachusetts
Univ Edinburgh
Hop La Pitie Salpetriere
Univ Michigan
Albert Einstein Hosp
Issue Date: 1-Jan-2005
Publisher: Mosby, Inc
Citation: American Heart Journal. St Louis: Mosby, Inc, v. 149, n. 1, p. 67-73, 2005.
Abstract: Background Evidence-based cardiac therapies are underutilized in elderly patients. We assessed differences in practice patterns, comorbidities, and in-hospital event rates, by age and type of acute coronary syndrome (ACS).Methods We studied 24165 ACS patients in 102 hospitals in 14 countries stratified by age.Results Approximately two-thirds of patients were men, but this proportion decreased with age. in elderly patients ( greater than or equal to 65 years), history of angina, transient ischemic attack/stroke, myocardial infarction(MI), congestive heart failure, coronary artery bypass graft (CABG) surgery, hypertension or atrial fibrillation were more common, and delay in seeking medical attention and non-ST-segment elevation MI were significantly higher. Aspirin, beta-blockers, thrombolytic therapy, statins and glycoprotein Ilb/Illa inhibitors were prescribed less, while calcium antagonists and angiotensin-converting enzyme inhibitors were prescribed more often to elderly patients. Unfractionated heparin was prescribed more often in young patients, while low-molecular-weight heparins were similarly prescribed across all age groups. Coronary angiography and percutaneous intervention rates significantly decreased with age. the rate of CABG surgery was highest among patients aged 65-74 years (8.1 %) and 55-6A years (7.7%), but reduced in the youngest (4.7%) and oldest (2.7%) groups. Major bleeding rates were,2-3% among patients aged < 65 years, and > 6% in those : 85 years. Hospital-mortality rates, adjusted for baseline risk differences, increased with age (odds ratio: 15.7 in patients greater than or equal to 85 years compared with those < 45 years).Conclusions Many elderly ACS patients do not receive evidence-based therapies, highlighting the need for clinical trials targeted specifically at elderly cohorts, and quality-of-care programs that reinforce the use of such therapies among these individuals.
ISSN: 0002-8703
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