Abstract

The study aimed to compare the clinical profile, management pattern, outcomes and comorbidities among two groups of ACS patients aged 80 years and above as very elderly (group I) vs those aged between 60 – 80 years as elderly (group II). Materials and Methods: This was a prospective observational study of 240 patients admitted to the CCU of atertiary care teaching hospital in Kerala (120 patients in each group) over a period of oneyear (2019-2020). Results: The mean age of the study population was (84.07 years in group I vs 67.54 years in group II), and the male: female ratio was(1.5: 1 vs 1.14:1). Atypical and delayed clinical presentations of ACS were more common in group I (33.3%vs12.5%,pvalue 0.0001and 62.5% vs 33.3%, p 0.0001, respectively). Among the cardiovascular risk factors, systemic hypertension was more common among group I patients (58.3% vs33.3%,p0.0001),while smoking(45%vs24.16%,p0.001),hypertriglyceridemia(20.8%vs8.3%,p0.006)and obesity was more often seen in group II(25%vs12.5%,p 0.0001) respectively. Regarding the ACS subtypes, NSTEMI was the most common ingroup I (54.16 % vs 50%), while it was STEMI in group II (45.83% vs 25% ). Group Ipatients were sicker, with more of complications including acute pulmonary edema,(41.6% vs 16.6%, p 0.0001), cardiogenic shock (7.5%vs 1.6%, p value 0.031). The in hospital mortality was significantly higher in group I (15.8% vs 3.3%, p 0.0001). Group I patients less often received guideline directed medical treatment ,p value0.0001.The rate of coronary angiography after ACS was much less in group I (25% vs 75%, p 0.120). Among patients with STEMI, group I patients underwent primary angioplasty less often (50% vs 90.9%, p 0.934). CABG surgery was not done for any patient in group I (0 vs 9.16%). Comorbidities like chronic kidney disease (23.3% vs 15.83% p value0.143 ), chronic obstructive pulmonary disease (18.3% vs16.6% p value 0.734) and stroke(24.16% vs 4.16% p value 0.0001) were more among group I patients. Conclusions: There is heterogeneity among the elderly ACS patients, with the octogenarian subset ofpatients demonstrating a more adverse clinical profile, higher rates of complications,mortality and comorbidities. There is a need for earlier diagnosis and optimal use ofmedical and interventional therapy in this vulnerable population to further improve theiroutcomes

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