Outcomes of a routine invasive strategy in elderly patients with non-ST-segment elevation myocardial infarction from 2005 to 2014: results from the PL-ACS registry

Background Elderly patients (>= 75 years old) with non-ST-segment elevation myocardial infarction (NSTEMI) represent a large subgroup of all cases. They are rarely included in randomized trials because of comorbidities and concerns about complications. Furthermore, invasive treatments are used less frequently in this patient group. The aim of this study was to analyze trends in invasive procedures and outcomes in elderly patients with NSTEMI from 2005 to 2014. Patients and methods We analyzed 68 978 elderly patients with NSTEMI enrolled in the prospective, nationwide Polish Registry of Acute Coronary Syndromes from 2005 to 2014. Results Elderly patients accounted for 34.9% of all patients with NSTEMI. There was an increase in the rate of coronary angiography from 19.1% in 2005-2007 to 83.5% in 2012-2014 among women (P<0.05) and from 26.0 to 87.5% among men (P<0.05). Simultaneously, there was an increase in percutaneous coronary intervention usage from 12.9% in 2005-2007 to 56.3% in 2012-2014 among women (P<0.05) and from 17.6 to 60.5% among men (P<0.05). On comparing the periods of 2005-2007 and 2012-2014, in-hospital mortality decreased considerably from 9.6 to 5.3% among women (P<0.05) and from 9.1 to 4.7% among men (P<0.05). In the same time period, the 12-month mortality ratio decreased: from 30.5 to 22.0% among women (P<0.05) and from 32.0 to 22.8% among men (P<0.05). In multivariate analysis, age was one of the most important factors associated with poorer outcome. With each increased decade of life, the outcomes worsened - the relative risk of mortality was 1.63 [95% confidence interval (CI): 1.59-1.68] for the in-hospital prognosis and 1.57 (95% CI: 1.55-1.59) for the 12-month prognosis. Invasive treatment strategy was the strongest factor associated with improved outcome, with a relative risk of 0.31 (95% CI: 0.29-0.33) for in-hospital mortality and 0.51 (95% CI: 0.49-0.52) for 12-month mortality, respectively. Conclusion Patients with NSTEMI benefit considerably from invasive procedures independent of age. In-hospital as well as 12-month outcomes in elderly patients improved markedly in the last decade as a result of the wide implementation of an invasive treatment strategy.