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• W3092427923 abstract "The number of very old patients admitted to intensive care units for acute coronary syndromes has increased gradually, but these patients are under-represented in randomized clinical trials. The aim of this study was to analyse mortality of nonagenarians compared with octogenarians admitted to an intensive care unit for acute coronary syndromes, to describe their management and to identify prognostic factors. Patients aged ≥ 80 years admitted to an intensive care unit (Croix-Rousse University Hospital, Lyon) with a diagnosis of acute coronary syndrome from 1 January 2013 to 31 December 2016 were included retrospectively. After exclusion of type 2 acute coronary syndromes, the data for 311 octogenarians and 92 nonagenarians were analysed using Kaplan-Meier curves and a multivariable Cox regression model. More than 70% of patients received renin-angiotensin-system blockers, beta-blockers and statins, without significant difference between nonagenarians and octogenarians. Nonagenarians were treated significantly less frequently with ticagrelor than octogenarians (P = 0.028). Overall, 97.8% of patients had a coronary angiogram, and 80.4% underwent percutaneous coronary intervention. At 5-year follow-up, the survival rate was 62.8% for nonagenarians compared with 73.1% for octogenarians (P = 0.007), but no significant difference was observed for cardiovascular mortality (P = 0.17). Global Registry of Acute Coronary Events (GRACE) score and increased age were significantly associated with higher mortality rate, while renin-angiotensin-system blockers, statins and ticagrelor were protective factors. Although overall mortality was higher in patients aged ≥ 90 years compared with those aged < 90 years with acute coronary syndromes, the overall survival reported here is acceptable. In addition to the effect of age, the difference in prognosis according to age may be explained, in part, by a non-optimal treatment strategy for older patients. La proportion des patients très âgés admis en soins intensifs cardiologiques (USIC) pour un syndrome coronaire aigu (SCA) a progressivement augmenté. Cette population est sous représentée dans les études randomisées. L’objectif est d’évaluer la mortalité des nonagénaires en comparaison des octogénaires admis pour un SCA en USIC et d’identifier les facteurs influençant le pronostic. Les patients ≥ 80 ans admis à l’USIC (hôpital de la Croix-Rousse, CHU de Lyon) avec un diagnostic de SCA ont été analysés rétrospectivement entre le 01 janvier 2013 et le 31 décembre 2016. Après exclusion des SCA de type 2, les données de 311 octogénaires et 92 nonagénaires ont été analysés par les courbes de Kaplan-Meier et les modèles de Cox ajustés. Plus de 70 % des patients ont été traités par les bloqueurs du système rénine-angiotensinogène (BSRA), les bêta-bloquants et statines sans différence significative selon l’âge. Les nonagénaires étaient moins fréquemment traités par le ticagrélor que les octogénaires (p = 0,0028). Parmi les patients, 97,8 % ont été explorés par une coronarographie, et 80,4 % une angioplastie coronaire. À 5 ans de suivi, la survie toute cause était de 62,8 % pour les nonagénaires contre 73,1 % pour les octogénaires (p = 0,007) avec une tendance non significative pour la mortalité cardiovasculaire (p = 0,17). L’âge avancé et le score de GRACE est significativement associé à la mortalité toute cause, à l’inverse les BSRA, les statines et le ticagrélor étaient des facteurs protecteurs. Malgré une mortalité supérieure chez les nonagénaires, leur survie globale paraît acceptable. Au-delà de l’effet de l’âge sur la mortalité, la surmortalité des nonagénaires pourrait s’expliquer par une moindre optimisation de la thérapeutique." @default.
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• W3092427923 date "2020-12-01" @default.
• W3092427923 modified "2023-10-16" @default.
• W3092427923 title "Therapeutic management and outcome of nonagenarians versus octogenarians admitted to an intensive care unit for acute coronary syndromes" @default.
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• W3092427923 doi "https://doi.org/10.1016/j.acvd.2020.05.020" @default.
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