Leczenie chorych w podeszłym wieku (≥ 80 lat) z zawałem serca bez uniesienia odcinka ST w referencyjnym ośrodku kardiologii interwencyjnej

In Poland the percentage of patients aged ≥ 65 years is over 13%, and of those aged ≥ 80 years more than 3%. Prognoses for upcoming years indicate a further, significant aging of both the Polish population. Ischaemic heart disease remains one of the main causes of death in elderly population. An insufficient body of evidence from clinical trials regarding treatment of elderly patients is the reason for individual recommendations contained in guidelines issued by cardiology societies referring to the treatment of that group of patients to be based mainly on expert opinions. A lower class of recommendations for elderly and very old patients is translated into the clinical practice, as those patients are less commonly treated according to the guidelines. The aim was to verify the hypothesis that referring elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) to the reference centre with an intention to treat them invasively improves their early and long-term prognosis. The analysis was performed using data stored in the hospitalization database at the Silesian Cardiology Centre in Zabrze (SCCS) and in the Polish Registry of Acute Coronary Syndromes (PL-ACS). To the group of patients hospitalised at the Silesian Cardiology Centre in Zabrze, a similar group of elderly patients, aged ≥ 80 lat, treated conservatively in hospitals and at wards possessing no abilities for invasive treatment during the same period of time, and entered to the PL-ACS register was matched using the “propensity score” method. Patients treated in the reference invasive cardiology centre more commonly received medication recommended by guidelines during their hospitalisation, including thienopyridines, IIb/IIIa GP inhibitors, statins, beta-adrenolytics and angiotensin-converting enzyme inhibitors. In the interventional cardiology centre. Percutaneous coronary intervention was performed in 74% of patients, coronary artery bypass grafting was performed or planned in 7.5%. Consequently, following a coronary angiography assessment only less than 8% of patients were qualified for conservative treatment (no revascularisation). Complications during the hospitalisation in the reference interventional cardiology centre (central nervous system stroke, another myocardial infarction, death) were similarly common as in the “propensity score” matched group treated non-invasively. However, major bleeding was more often encountered in the invasive centre. No differences in terms of early mortality (30 days) were also found between groups. However the 1-year and 2-year mortality was statistically significantly lower for patients treated in the interventional cardiology clinic, compared to both all patients treated in non-invasive hospitals, and to the “propensity score” matched group. No group for which a treatment in the reference interventional cardiology centre would be associated with an unfavourable prognosis was identified. In conclusion, treatment in the reference interventional cardiology centre and application of the invasive strategy and modern pharmacotherapy recommended by valid guidelines reduce the long-term mortality of elderly NSTEMI patients in a highly advanced age, despite the observed rise of incidence of severe bleeding events.