Comparison of the effects of interventional treatment and conservative treatment on mortality in six months in elderly patients with non-ST segment elevation acute coronary syndrome

Introduction Coronary artery disease (CAD) is a degenerative and inflammatory disorder which commonly effects middle-aged and elderly population. Although current guidelines recommend similar interventional strategies for elderly compared to young and middle-aged population, there is no randomized controlled trial on this issue. Also, elderly patients do not benefit from interventional treatment of CAD as much as the rest of the population do. In this study, we aimed to compare 6 month-mortality of elderly patients (>65 years of age) presented with non-ST segment elevation acute coronary syndrome (NSTEACS) treated with interventional methods and that of patients treated by conservative approach. Material and Methods A total of 300 patients older than 65 years-of-age presented NSTEACS between Jan'11 – May'13 were enrolled to this retrospectively designed study. Half of these patients were treated by interventional approach, and the rest of were treated conservatively. Demographic data, medications on admission, vital signs, biochemical and haematological parameters, cardiac biomarkers, ECGs, and routine transthoracic echocardiographic examinations of the patients were recorded from digital patient files of our hospital. GRACE and CRUSADE scores were calculated for each patient. Six month-mortality was interrogated through phone visits. Patients treated by interventional approach and conservatively were compared in terms of all these parameters. Results Mean age of the study population was 74.7 ± 6.3 years, and 157 (52%) of them were female. Conservative treatment group was significantly older (75.7 ± 6.7 vs 73.6 ± 5.9 years; p = 0.05). As the age gets older, interventional treatment approach had been chosen less (age = 65-74 years, 57%; age = 75-85 years, 45%; age > 85 years, 21% had been treated interventionally). Study groups were comparable in terms of GRACE scores, CRUSADE scores, left ventricular ejection fraction, medical history of CAD, diabetes mellitus, blood pressure and heart rate on admission, and frequency of bleeding complication. 6 month-mortality of study population was 13.6%, while this was lower in patients treated by interventional approach (8.6% vs. 18.6%; p = 0.018). The predictors of 6 month-mortality were found as high CRUSADE bleeding risk, conservative approach, high troponin value. Discussion According to the age-based distribution in our country, despite higher prevalence of young ages, the elderly patients constitutes the majority of the patients presented with NSTEACS. However, elderly population receiving invasive management is stil not high. In our study, the mortality rate in elderly population whom received invasive therapeutic management, was found to be lower than the group remaining conservative. Thus, the benefit in mortality rate can be achieved in older patients with invasive therapeutic and diagnostic approach after a precise risk evaluation. Conclusion In our study, we suggest that interventional treatment of NSTEACS in elderly is associated with decrease in 6 month-mortality and an independent predictor of 6 month-survival. Our results support that elderly patients deserve interventional treatment options after their risk assessment. Key words: Elderly patients, interventional treatment, 6 month mortality