Abstract
Introduction
In this retrospective study we examined adverse cardiovascular outcomes in patients under and over 80 years of age. Two cohorts were analysed: those undergoing coronary angiography and those treated for acute coronary syndrome (ACS). The first aim was to asses outcomes in those selected for invasive strategy including elective, urgent, or emergency procedures. The second aim was to compare invasive, excluding staged procedures, versus conservative management in the whole cohort presenting with ACS.
Methods
Data was retrospectively collected from patients treated at Conquest Hospital between October and December 2023 using electronic records, TOMCAT, and MINAP databases. Cardiovascular risk profiles, treatment strategies, and outcomes were compared between age groups (<80 vs ≥80). Subsequent cardiovascular events and all-cause mortality were recorded over a follow-up of 13-months.
Results
Among 168 patients undergoing angiography, 84% were under 80 and 16% were 80 or older. Older patients had higher all-cause mortality (18.5% vs 5.0%) and cardiovascular death (7.4% vs 0.7%), while non-fatal MI rates were similar (9.2% vs 11.1%). In the ACS cohort, conservative management was more common in those ≥80. Among patients <80, conservative management was associated with significantly higher all-cause (38.5% vs 7.1%) and cardiovascular mortality (15.4% vs 0.7%). In the ≥80 group, cardiovascular mortality was also higher with conservative management (16.7% vs 7.4%), but all-cause mortality showed a less-pronounced difference (25% vs 18.5%).
Conclusion
While age alone did not preclude angiography at our centre, invasive strategies were less frequent in older patients. Invasive management was associated with lower cardiovascular mortality across age groups, but in patients ≥80, all-cause mortality remained high regardless of treatment. This suggests invasive strategies reduce risk of cardiovascular death regardless of age but may not improve overall survival in the older group. Our findings support continued use of angiography as the standard care for patients suitable for intervention, irrespective of age.