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Characteristics, management, and outcomes of 5,557 patients age > or =90 years with acute coronary syndromes: results from the CRUSADE Initiative.

Publication ,  Journal Article
Skolnick, AH; Alexander, KP; Chen, AY; Roe, MT; Pollack, CV; Ohman, EM; Rumsfeld, JS; Gibler, WB; Peterson, ED; Cohen, DJ
Published in: J Am Coll Cardiol
May 1, 2007

OBJECTIVES: The goal of this work was to explore the treatment and outcomes of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) age > or =90 years. BACKGROUND: The elderly are often excluded from clinical trials of NSTE-ACS and are underrepresented in clinical registries. METHODS: We used data from the CRUSADE registry to study 5,557 patients with NSTE-ACS age > or =90 years and compared their baseline characteristics, treatment patterns, and in-hospital outcomes with a cohort age 75 to 89 years (n = 46,270). RESULTS: Although both groups had much in common, compared with the younger elderly, the older elderly were less likely to be diabetic, smokers, or obese. Among patients without contraindications, the older elderly were less likely to receive glycoprotein IIb/IIIa inhibitors and statins during the first 24 h and were less likely to undergo cardiac catheterization within 48 h. The older elderly were more likely to die (12.0% vs. 7.8%) and experienced more frequent adverse events (26.8% vs. 21.3%) during the hospitalization-differences that persisted after adjustment for baseline patient and hospital characteristics. Increasing adherence to guideline-recommended therapies was associated with both increased bleeding and a graded reduction in risk-adjusted in-hospital mortality across both age groups. CONCLUSIONS: In this large population of nonagenarians and centenarians with NSTE-ACS, increasing adherence to guideline-recommended therapies was associated with decreased mortality. These findings reinforce the importance of optimizing care patterns for even the oldest patients with NSTE-ACS, while examining novel approaches to reduce the risk of bleeding in this rapidly expanding patient population.

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

May 1, 2007

Volume

49

Issue

17

Start / End Page

1790 / 1797

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Syndrome
  • Survival Rate
  • Registries
  • Practice Guidelines as Topic
  • Myocardial Ischemia
  • Male
  • Humans
  • Hospital Mortality
  • Guideline Adherence
 

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Skolnick, A. H., Alexander, K. P., Chen, A. Y., Roe, M. T., Pollack, C. V., Ohman, E. M., … Cohen, D. J. (2007). Characteristics, management, and outcomes of 5,557 patients age > or =90 years with acute coronary syndromes: results from the CRUSADE Initiative. J Am Coll Cardiol, 49(17), 1790–1797. https://doi.org/10.1016/j.jacc.2007.01.066
Skolnick, Adam H., Karen P. Alexander, Anita Y. Chen, Matthew T. Roe, Charles V. Pollack, E Magnus Ohman, John S. Rumsfeld, W Brian Gibler, Eric D. Peterson, and David J. Cohen. “Characteristics, management, and outcomes of 5,557 patients age > or =90 years with acute coronary syndromes: results from the CRUSADE Initiative.J Am Coll Cardiol 49, no. 17 (May 1, 2007): 1790–97. https://doi.org/10.1016/j.jacc.2007.01.066.
Skolnick AH, Alexander KP, Chen AY, Roe MT, Pollack CV, Ohman EM, et al. Characteristics, management, and outcomes of 5,557 patients age > or =90 years with acute coronary syndromes: results from the CRUSADE Initiative. J Am Coll Cardiol. 2007 May 1;49(17):1790–7.
Skolnick, Adam H., et al. “Characteristics, management, and outcomes of 5,557 patients age > or =90 years with acute coronary syndromes: results from the CRUSADE Initiative.J Am Coll Cardiol, vol. 49, no. 17, May 2007, pp. 1790–97. Pubmed, doi:10.1016/j.jacc.2007.01.066.
Skolnick AH, Alexander KP, Chen AY, Roe MT, Pollack CV, Ohman EM, Rumsfeld JS, Gibler WB, Peterson ED, Cohen DJ. Characteristics, management, and outcomes of 5,557 patients age > or =90 years with acute coronary syndromes: results from the CRUSADE Initiative. J Am Coll Cardiol. 2007 May 1;49(17):1790–1797.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

May 1, 2007

Volume

49

Issue

17

Start / End Page

1790 / 1797

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Syndrome
  • Survival Rate
  • Registries
  • Practice Guidelines as Topic
  • Myocardial Ischemia
  • Male
  • Humans
  • Hospital Mortality
  • Guideline Adherence