Short and long term outcomes of patients aged 65 and over followed in the coronary intensive care unit of Akdeniz University Hospital with acute coronary syndrome: Comparison of invasive and conservative treatment

Coronary artery disease is an important cause of mortality and morbidity worldwide. Thanks to the development of medicine, the survival time of patients is prolonged. However, there is also an increase in the number of elderly patients with acute coronary syndrome (ACS). In addition to coronary artery disease, other comorbidities increase with increasing age. This affects the treatment options and survival of patients with ACS. Current guidelines for the treatment of non-ST-elevation acute coronary syndrome (NSTE-ACS) recommend an invasive strategy for eligible elderly patients. Complications are observed more frequently in the invasive approach in elderly patients due to comorbidities. Although there are studies recommending invasive approach in the elderly, there are also opposing views in which no difference is found in conservative approach. The aim of our study was to evaluate the short- and long-term outcomes in patients aged 65 years and older who were followed up in the coronary intensive care unit of Akdeniz University Hospital with ACS and to investigate the effect of preferred invasive and conservative treatment on in-hospital and 1-year post-discharge survival. Our study is a single-centre, retrospective study. Between 2016 and 2021, 362 patients aged 65 years and older who were followed up in the coronary intensive care unit of Akdeniz University Hospital with ACS and who did not meet the exclusion criteria were included. Patients were divided into 2 groups as percutaneous coronary intervention (PCI) and medical treatment. GRACE and CRUSADE scores were calculated in all patients. SYNTAX scores were calculated in patients who had no known history of coronary artery bypass grafting (CABG) and underwent coronary angiography (CAG). In-hospital haemorrhage and in-hospital death were evaluated for short-term outcomes. For long-term outcomes, 1-year post-discharge death and 1-year major adverse cardiovascular events were evaluated. These outcomes were compared with GRACE, CRUSADE and SYNTAX scores. The independent variables were determined. Of the patients, 225 (62.2%) were male and 137 (37.8%) were female. The mean age was 74.66±7.07 years and the patient ages ranged between 65 and 99 years. Of the included patients, 285 (78.7%) were NSTE-ACS patients and 77 (21.3%) were STEMI patients. CAG was performed in 297 (82%) of the patients, and 65 (18%) patients received direct medical treatment without CAG. Of the patients who underwent CAG, 78 (26.3%) received medical treatment and 219 (73.7%) received PCI. One-year MACE, death within one year after discharge, and in-hospital death at admission were found to be statistically significantly higher in the medical treatment group compared to the PCI group. The patients who were lost within one year after discharge had higher SYNTAX (p=0.019), GRACE (p=0.001), and CRUSADE (p=0.001) scores and longer CICU stays (p=0.001) compared to the surviving patients. In patients with observed MACE, GRACE and CRUSADE scores were higher (p=0.001 for both), and EF value was observed to be lower (p=0.001). The SYNTAX score was not found to be a determinant in the development of MACE (p>0.05). There was no difference in contrast nephropathy between patients who underwent coronary angiography and were decided to be medically monitored and those who underwent PCI. In the Cox regression analysis, GFR, GRACE, SYNTAX, and EF were found to be independent variables for one-year mortality. However, for one-year MACE, the GRACE score and dyslipidemia were found to be independent variables. Our study highlights the importance of strict dyslipidemia control in preventing post-procedural MACE in ACS patients. In conclusion, after a thorough preliminary evaluation, invasive treatment can be safely preferred in elderly ACS patients.