Introduction: Age is an important prognostic factor in acute coronary syndromes (ACS). An invasive strategy has been shown to benefit many non-ST elevation ACS populations; however, there is some controversy regarding patients who are more susceptible to procedure-related complications, such as the elderly, an under-represented population in the studies on this subject.
Objective: We aimed to compare the in-hospital and long-term prognosis of elderly patients with non-ST elevation ACS treated with either invasive procedures or a conservative strategy, and to characterize the patients selected for an early invasive approach.
Methods: This observational, longitudinal, prospective and continuous study included 307 patients aged over 75 years consecutively admitted for non-ST elevation ACS. They were divided into two groups, according to the approach adopted: Group A (n=91)--patients treated with an early invasive strategy; and Group B (n=216)--patients treated conservatively. The median clinical follow-up was 18 months.
Results: The subjects who were treated invasively were younger (79.8 +/- 3.2 vs. 81.4 +/- 3.9 years, p < 0.001) and more often male (63.7 vs. 50.9%, p = 0.04), had a higher incidence of previous coronary artery disease, were more often treated with clopidogrel, and had a longer hospital stay (5.8 +/- 3.1 vs. 4.9 +/- 2.6 days, p = 0.01). Patients managed conservatively presented higher Killip class, and were more often treated with diuretics during hospitalization. The group treated by an invasive approach presented a higher incidence of in-hospital complications (13.6 vs. 4.9%, p = 0.009), but there were no significant differences in mortality rates. Multivariate analysis showed that an invasive strategy was an independent predictor of in-hospital morbidity (OR = 3.55). In follow-up, rates of MACE (56.3 vs. 33.3%, p = 0.002) and death (32.5 vs. 13.8%, p = 0.007) were higher in the group that received conservative treatment, and an invasive strategy was a protective factor against MACE; the strongest predictor of mortality was left ventricular ejection fraction <50%.
Conclusions: Although an invasive strategy was associated with increased in-hospital complications, it was shown to confer a better long-term prognosis. These data show that age should not be the only criterion in selecting patients for an invasive strategy and favor early adoption of this approach in the elderly.