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Clinical outcomes in nonagenarians undergoing emergent coronary angiography: a retrospective analysis
Session:
SESSÃO DE POSTERS 10 - GERIATRIA CARDIOVASCULAR: MOSTRA-ME OS DADOS!
Speaker:
Joana Conde Gonçalves
Congress:
CPC 2025
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Cartazes
FP Number:
---
Authors:
Joana Conde Gonçalves; Emanuel de Oliveira; Mariana Paiva; Bernardo Cruz; Paula Dias; Rui Almeida; Rui Rodrigues
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Background:</span></strong><span style="font-family:"Calibri",sans-serif"> Management of acute coronary syndrome (ACS) in elderly patients presents unique challenges due to frailty and higher burden of comorbidities. The impact of emergent coronariography in these patients remains a subject of debate. This study investigates the clinical profile, in-hospital outcomes and 2-year follow-up of nonagenarians presenting with ST elevation ACS (STE-ACS), focusing on comparing those undergoing emergent coronary angiography with a matched control group. </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Methods:</span></strong> A retrospective analysis of patients aged ≥90 years admitted with STE-ACS to our institution between january 2008 and june 2024 was performed. Clinical data were collected from institutional registries. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause mortality, ischemic stroke, recurrent ACS and hospitalization for acute heart failure.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Results</strong>: Fifty-one patients (median age 92±2 years; 59% female) were included. Comorbidities were highly prevalent (hypertension 82.4%, diabetes 15.7%, dyslipidemia 51%, smoking 15.7%, obesity 15.7%, atrial fibrillation 17.6%, chronic kidney disease 19.6%). The median Clinical Frailty Score was 4. Most ACS cases (64.7%) involved the anterior wall. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Emergent coronary angiography was performed in 82.4% of patients. The left anterior descending artery was the most frequent culprit site and revascularization was achieved in just over half of the patients, predominantly via stent implantation.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Clinically, 27.4% of patients progressed to Killip class III/IV and only 29.4% retained preserved ejection fraction post-event. In-hospital mortality was 31.4%. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">No significant differences in mortality were observed between patients undergoing emergent angiography and controls (p=0.588). Similarly, 2-year follow-up revealed no significant differences in mortality (p=0.687) or MACE (p=0.602). Overall, 56.9% of patients experienced MACE and 52.9% died within the follow-up period.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusions</strong>: Nonagenarians with STE-ACS represent a high-risk population. Emergent coronary angiography was not associated with improved survival or reduced MACE in this cohort. These findings underscore the need for individualized therapeutic strategies in this vulnerable population.</span></span></p>
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