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Comparison of Outcomes of Acute Coronary Syndrome in Patients ≥80 Years Versus Those <80 Years in Israel from 2000 to 2013

  • Michael Shechter
    Correspondence
    Corresponding author: Tel: +972 3 5302617; fax: +972 3 6780581.
    Affiliations
    Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel

    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Author Footnotes
    † This work was performed in partial fulfillment of the MD thesis requirements of the Sackler Faculty of Medicine, Tel Aviv University.
    Roy Rubinstein
    Footnotes
    † This work was performed in partial fulfillment of the MD thesis requirements of the Sackler Faculty of Medicine, Tel Aviv University.
    Affiliations
    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Ilan Goldenberg
    Affiliations
    Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel

    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Shlomi Matetzki
    Affiliations
    Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel

    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • on behalf of theAcute Coronary Syndrome Israel Survey (ACSIS)
  • Author Footnotes
    † This work was performed in partial fulfillment of the MD thesis requirements of the Sackler Faculty of Medicine, Tel Aviv University.
      Although patients ≥80 years old constitute the fastest-growing segment of the population and have a high prevalence of coronary artery disease, few data exist regarding the outcome of octogenarians with acute coronary syndrome (ACS). In a retrospective study based on data of 13,432 ACS patients who were enrolled in the ACS Israel Survey, we first evaluated the clinical outcome of 1,731 ACS patients ≥80 years (13%) compared with 11,701 ACS patients <80 years (87%) hospitalized during 2000 to 2013. Second, we evaluated the clinical outcome of patients ≥80 years hospitalized during the 2000 to 2006 (“early”) period (n = 1,037) compared with those of the same age group of patients hospitalized during the 2008 to 2013 (“late”) period (n = 694). Implementation of the ACS AHA/ACC/ESC therapeutic guidelines was lower in ACS patients ≥80 years compared with patients <80 years. Multivariate Cox regression analysis demonstrated a worse 1-year survival rate in the ACS patients ≥80 years compared with those <80 years. During the late period, patients ≥80 years were more frequently treated with guideline-recommended therapies compared with patients from the same age group who were hospitalized in the early period. Multivariate Cox regression analysis demonstrated a better 1-year survival rate of patients ≥80 years during the late period compared with the early period (hazard ratio 1.17, 95% confidence interval 1.15 to 1.61; p = 0.01). In addition, adverse outcome rates of ACS patients ≥80 years were significantly higher compared with those of patients <80 years. However, survival rates of ACS patients ≥80 years were improved over the 200 to 2013 period.
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