Impact of age on management and outcome of acute coronary syndrome: Observations from the Global Registry of Acute Coronary Events (GRACE)

Show simple item record Avezum, A. Makdisse, M. Spencer, F. Gore, J. M. Fox, KAA Montalescot, G. Eagle, K. A. White, K. Mehta, R. H. Knobel, E. Collet, J. P. GRACCE Investigators 2016-01-24T12:37:33Z 2016-01-24T12:37:33Z 2005-01-01
dc.identifier.citation American Heart Journal. St Louis: Mosby, Inc, v. 149, n. 1, p. 67-73, 2005.
dc.identifier.issn 0002-8703
dc.description.abstract Background Evidence-based cardiac therapies are underutilized in elderly patients. We assessed differences in practice patterns, comorbidities, and in-hospital event rates, by age and type of acute coronary syndrome (ACS).Methods We studied 24165 ACS patients in 102 hospitals in 14 countries stratified by age.Results Approximately two-thirds of patients were men, but this proportion decreased with age. in elderly patients ( greater than or equal to 65 years), history of angina, transient ischemic attack/stroke, myocardial infarction(MI), congestive heart failure, coronary artery bypass graft (CABG) surgery, hypertension or atrial fibrillation were more common, and delay in seeking medical attention and non-ST-segment elevation MI were significantly higher. Aspirin, beta-blockers, thrombolytic therapy, statins and glycoprotein Ilb/Illa inhibitors were prescribed less, while calcium antagonists and angiotensin-converting enzyme inhibitors were prescribed more often to elderly patients. Unfractionated heparin was prescribed more often in young patients, while low-molecular-weight heparins were similarly prescribed across all age groups. Coronary angiography and percutaneous intervention rates significantly decreased with age. the rate of CABG surgery was highest among patients aged 65-74 years (8.1 %) and 55-6A years (7.7%), but reduced in the youngest (4.7%) and oldest (2.7%) groups. Major bleeding rates were,2-3% among patients aged < 65 years, and > 6% in those : 85 years. Hospital-mortality rates, adjusted for baseline risk differences, increased with age (odds ratio: 15.7 in patients greater than or equal to 85 years compared with those < 45 years).Conclusions Many elderly ACS patients do not receive evidence-based therapies, highlighting the need for clinical trials targeted specifically at elderly cohorts, and quality-of-care programs that reinforce the use of such therapies among these individuals. en
dc.format.extent 67-73
dc.language.iso eng
dc.publisher Mosby, Inc
dc.relation.ispartof American Heart Journal
dc.rights Acesso restrito
dc.title Impact of age on management and outcome of acute coronary syndrome: Observations from the Global Registry of Acute Coronary Events (GRACE) en
dc.type Artigo
dc.contributor.institution Dante Pazzanese Cardiol Inst
dc.contributor.institution Universidade Federal de São Paulo (UNIFESP)
dc.contributor.institution Univ Massachusetts
dc.contributor.institution Univ Edinburgh
dc.contributor.institution Hop La Pitie Salpetriere
dc.contributor.institution Univ Michigan
dc.contributor.institution Albert Einstein Hosp
dc.description.affiliation Dante Pazzanese Cardiol Inst, BR-04012909 São Paulo, Brazil
dc.description.affiliation Universidade Federal de São Paulo, Div Cardiol, São Paulo, Brazil
dc.description.affiliation Univ Massachusetts, Sch Med, Worcester, MA USA
dc.description.affiliation Univ Edinburgh, Royal Infirm Edinburgh, Edinburgh, Midlothian, Scotland
dc.description.affiliation Hop La Pitie Salpetriere, Serv Cardiol, Paris, France
dc.description.affiliation Univ Michigan, Hlth Syst, Ann Arbor, MI USA
dc.description.affiliation Albert Einstein Hosp, Intens Care Unit, São Paulo, Brazil
dc.description.affiliationUnifesp Universidade Federal de São Paulo, Div Cardiol, São Paulo, Brazil
dc.identifier.doi 10.1016/j.ahj.2004.06.003
dc.description.source Web of Science
dc.identifier.wos WOS:000226387000010


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