Early Invasive versus Conservative Treatment Strategies in Octogenarians with Acute Coronary Syndrome: One-year Clinical Outcome, a Single Centre Experience.

Thomachan, Vipin

Early Invasive versus Conservative Treatment Strategies in Octogenarians with Acute Coronary Syndrome: One-year Clinical Outcome, a Single Centre Experience.

Tuesday, May 21, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Vipin Thomachan, M.D., FSCAI , AL AIN HOSPITAL, Al Ain, United Arab Emirates

Abdullah Shehab, M.D., Ph.D., FSCAI , UAE University, Al-Ain, United Arab Emirates

Mohammed Siddiqui, M.D. , AL AIN HOSPITAL, Al Ain, United Arab Emirates

Ali Shamsi, M.D. , Tawam Hospital, Al Ain, United Arab Emirates

Mohammed Elharari, M.D. , AL AIN HOSPITAL, Al Ain, United Arab Emirates

Mohammed ALMehairi, M.D. , AL AIN HOSPITAL, Al Ain, United Arab Emirates

Mohammed Nawas, M.D. , AL AIN HOSPITAL, Al Ain, United Arab Emirates

Taha Elshafie, M.D. , AL AIN HOSPITAL, Al Ain, United Arab Emirates

Fahd Elsayed, M.D. , AL AIN HOSPITAL, Al Ain, United Arab Emirates

Ijaz Majeed, M.D. , AL AIN HOSPITAL, Al Ain, United Arab Emirates

Doaa Elkholy, M.D. , AL AIN HOSPITAL, Al Ain, United Arab Emirates

Background:
This retrospective data analysis was aimed to evaluate whether octogenarians would benefit from an Early Invasive Strategy(EIS),compared to Conservative Treatment Strategy(CTS).

Methods:
Retrospective analysis of Electronic Medical Records(Cerner)of octogenarians admitted between the year 2014 and 2017 with a diagnosis of ACS.The primary endpoint of the study was all-cause mortality,cardiac mortality and re-hospitalization at 12months.

Results:
Of the 164 octogenarians,60(36.6%) had Percutaneous Coronary Intervention(PCI)and 104(63.4%)were treated conservatively.Mean age was 85.5 ± 4.6 years and 86.1±5.7years respectively.NSTEMI was the most common form of presentation (89.4% in CTS;73.3% in EIS). CTS group had higher in-hospital mortality compared to EIS group (17.3%vs.8.3%;p=0.1108).Six months all-cause mortality was higher in the CTS group (26.9%vs.11.7%;p=0.0024).Similarly,one-year all-cause mortality was higher in the CTS group than in EIS strategy(41.4%vs.16.7%;p=0.0012).Cardiac mortality at one year was also high in the CTS group(28.8%vs.10%;p=0.0052). Average number of re-hospitalizations per patient in the following year due to the cardiac cause was high in the CTS group (1.8/year vs.0.5/year;p<0.0001).Past coronary revascularisation(31.7% in CTS vs.15% in EIS;p=0.0186) and CKD(46.2% in CTS vs. 35% in EIS;p0.0013)were higher in CTS group,but not statistically significant.Other baseline variables were similar and comparable.Subgroup analysis of EIS showed significant one-year mortality difference between Trans-Radial PCI and Trans-Femoral PCI (9.3% vs.35.3%;p=0.0157).

Conclusions:
This study shows that EIS,though underutilized in octogenarians with,is technically feasible with successful coronary revascularization in the majority of patients and appears superior to CTS.EIS in octogenarians was associated with low in-hospital mortality,six and twelve-month all-cause mortality and twelve-month cardiac mortality.EIS was also associated with low re-hospitalization rate.Early Invasive Strategy is a reasonably safe treatment option for ACS in octogenarians and trans-radial PCI appears to be a safer and superior option than trans-femoral.