[Risk factors for adverse outcomes after percutaneous coronary intervention in patients aged over 75 years with non-ST-segment elevation acute coronary syndrome.]
TL;DR
Among patients over 75 years of age, the PCI group had a higher incidence of adverse events, total complications, and mortality compared to the conservative management group, and the strongest predictors of mortality in this group were patient age, elevated CPK-MB levels at admission, and total complications.
Abstract
Myocardial infarction is a life-threatening condition with high mortality, which is especially important for patients over 75 years of age who have an increased risk of complications and death. Objective - to assess the incidence of in-hospital mortality and adverse cardiovascular events in patients aged over 75 years with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) who underwent percutaneous coronary intervention. An analysis of data from a prospective registry of patients with ACS hospitalized in the vascular center based on the Alexandrovskaya City Hospital from January 2016 to November 2024 was performed. The initial sample included 14 420 cases of hospitalization, including 10 126 patients with NSTE-ACS. For the analysis, patients were stratified into four groups: 1st - up to 60 years old; 2nd - 60-74 years old; 3rd - 75-89 years old; 4th - 90 years and older. Data processing was performed using Excel, Jamovi, IBM SPSS Statistic 24, R statistical programs. Values of p<0,05 were considered statistically significant. Coronary angiography was performed in 98,6 % of patients. With increasing age, the following are noted: an increase in the proportion of women, an increase in the number of comorbidities, the Charlson comorbidity index, the number of points on the Killip, CRUSADE, GRACE scales, an increase in the number of complications and fatal outcomes. Among patients over 75 years of age, the PCI group had a higher incidence of adverse events, total complications, and mortality compared to the conservative management group. The strongest predictors of mortality in this group were patient age, elevated CPK-MB levels at admission, and total complications. Predictors of the composite endpoint were elevated CPK-MB levels, AIM Score, and systolic blood pressure at admission. Elderly patients and long-term survivors with MI represent a high-risk group, necessitating an individualized and balanced approach at all stages of treatment. Further research is needed to determine optimal treatment strategies for non-ST-elevation ACS in older age groups.