Improving in-hospital mortality in elderly patients after acute coronary syndrome-A nationwide analysis of 97,220 patients in Taiwan during 2004-2008

Background: Elderly patients seem to have especially poor outcomes after acquiring acute coronary syndrome (ACS). We conducted this study to examine the in-hospital mortality by utilization of invasive coronary therapies and age in a nationwide population in Taiwan. Methods: This observational study was conducted on a retrospective cohort from January 2004 to December 2008. Epidemiological features, including incidence rate and clinical characteristics of ACS in a Chinese population were investigated. Risk factors of in-hospital mortality, including myocardial infarction, shock, previous history of stroke, chronic kidney disease, diabetes mellitus, congestive heart failure, pneumonia, chronic obstructive pulmonary disease, dementia, peripheral arterial occlusive disease, septicemia and the use of invasive coronary procedures, were explored using a logistic regression model. Results: A total of 97,220 patients were enrolled, and 53.6% of them were elderly. A significant decrease in the utilization rate of invasive coronary therapies (diagnostic coronary angiography and PCI) and increased in-hospital mortality (p<0.001) were observed as patient age increased. Adjusted multivariate logistic regression analysis revealed that the impact of PCI in reducing in-hospital mortality is consistent across age groups, including those older than 75 years old. Conclusions: Our nationwide study provides evidence that PCI is associated with significant improvement of in-hospital mortality in patients with ACS. Even the very elderly patients could benefit from PCI. However, currently the utilization rate of PCI in the aging population still does not present enough. A prospective study is indicated to corroborate the findings of this study. (C) 2011 Elsevier Ireland Ltd. All rights reserved.