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Unfortunate impact of age on the management and outcomes of unstable angina and non-ST elevation myocardial infarction (the GUARANTEE registry)

Publication ,  Journal Article
Gurjeva, OS; Roe, MT; Murphy, SA; Moliterno, DJ; Cannon, CP
Published in: Critical Pathways in Cardiology
June 1, 2005

Few data are available from the registries on the impact of age and gender on treatment and outcomes of patients admitted for unstable angina and non-ST elevation myocardial infarction (UA/NSTEMI). We examined the clinical characteristics, differences in management and outcomes, associated with age in 2948 consecutive patients with UA/NSTEMI. Prospectively collected data from the Global Unstable Angina Registry and Treatment Evaluation (GUARANTEE) registry were analyzed, comparing patients older than 75 years of age and those 75 years and younger. Patients presenting at a younger age, both men and women, were more likely to have a family history of coronary artery disease, to be current smokers, and to have hypercholesterolemia (P < 0.001). Older patients more commonly had a prior history of stroke, angina, myocardial infarction (MI), and congestive heart failure (P < 0.05), and had more diffuse disease on angiography (P < 0.001). Although older women more often "ruled-in" for MI on admission, they were less likely to be cared for by a cardiologist (P < 0.05). A gradient in the use of cardiac catheterization was seen, with greatest use in younger men, 54.2% versus 47.4% for younger women, 43.1% for older men, and the lowest use in older women, 34.5% (P < 0.01). An opposite gradient of in-hospital mortality was seen, with 0.7%, 0.7%, 0.9%, and 3.2% across the 4 groups, respectively, with older women having worse outcomes (P = 0.008). Unfortunately, a "reverse targeting" of procedures to patient risk was seen among elderly, even when stratified by gender, with older patients being higher risk, but less likely to receive appropriate procedures. To improve the outcomes of elderly men and women with UA/NSTEMI, they should be managed more aggressively. Copyright © 2005 by Lippincott Williams & Wilkins.

Duke Scholars

Published In

Critical Pathways in Cardiology

DOI

ISSN

1535-282X

Publication Date

June 1, 2005

Volume

4

Issue

2

Start / End Page

81 / 87

Related Subject Headings

  • Cardiovascular System & Hematology
  • 1103 Clinical Sciences
  • 1102 Cardiorespiratory Medicine and Haematology
 

Citation

APA
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Gurjeva, O. S., Roe, M. T., Murphy, S. A., Moliterno, D. J., & Cannon, C. P. (2005). Unfortunate impact of age on the management and outcomes of unstable angina and non-ST elevation myocardial infarction (the GUARANTEE registry). Critical Pathways in Cardiology, 4(2), 81–87. https://doi.org/10.1097/01.hpc.0000164658.06135.a2
Gurjeva, O. S., M. T. Roe, S. A. Murphy, D. J. Moliterno, and C. P. Cannon. “Unfortunate impact of age on the management and outcomes of unstable angina and non-ST elevation myocardial infarction (the GUARANTEE registry).” Critical Pathways in Cardiology 4, no. 2 (June 1, 2005): 81–87. https://doi.org/10.1097/01.hpc.0000164658.06135.a2.
Gurjeva OS, Roe MT, Murphy SA, Moliterno DJ, Cannon CP. Unfortunate impact of age on the management and outcomes of unstable angina and non-ST elevation myocardial infarction (the GUARANTEE registry). Critical Pathways in Cardiology. 2005 Jun 1;4(2):81–7.
Gurjeva, O. S., et al. “Unfortunate impact of age on the management and outcomes of unstable angina and non-ST elevation myocardial infarction (the GUARANTEE registry).” Critical Pathways in Cardiology, vol. 4, no. 2, June 2005, pp. 81–87. Scopus, doi:10.1097/01.hpc.0000164658.06135.a2.
Gurjeva OS, Roe MT, Murphy SA, Moliterno DJ, Cannon CP. Unfortunate impact of age on the management and outcomes of unstable angina and non-ST elevation myocardial infarction (the GUARANTEE registry). Critical Pathways in Cardiology. 2005 Jun 1;4(2):81–87.

Published In

Critical Pathways in Cardiology

DOI

ISSN

1535-282X

Publication Date

June 1, 2005

Volume

4

Issue

2

Start / End Page

81 / 87

Related Subject Headings

  • Cardiovascular System & Hematology
  • 1103 Clinical Sciences
  • 1102 Cardiorespiratory Medicine and Haematology