Chest pain and acute coronary syndrome in octogenarians admitted to the Emergency Department
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ORIGINAL ARTICLE
Chest pain and acute coronary syndrome in octogenarians admitted to the Emergency Department James Samir Díaz‑Betancur1 · Juan Manuel Martínez2 · Juan Gabriel Zapata3 · Isabel Marín‑Orozco4 Received: 28 July 2020 / Accepted: 6 October 2020 © Springer Nature Switzerland AG 2020
Abstract Background Although chest pain and acute coronary syndrome (ACS) are among the most common complaints in the Emergency Departments (ED), little is known about this topic in the octogenarian population. Objectives This study aimed to describe the clinical presentation and to evaluate survival time according to the ACS type in a group of 80-year-old or over patients admitted for chest pain to an ED. Methods Patients were classified according to the discharge diagnosis. A multivariable Cox regression analysis was done to assess the association between ACS type and mortality with the non-ACS chest pain group as the reference category. Results ACS was diagnosed in 170 of the 391 patients analyzed and 51% of ACS patients were female. Within the ACS patients, 18.8% presented STEMI, 57% NSTEMI, and 24% unstable angina (UA). Most of the patients were treated conservatively. In the adjusted analysis, the incidence of death at 40 months of follow-up was higher in patients with STEMI (HR 3.24; CI 1.59–6.56) than NSTEMI (HR 2.53; CI 1.56–4.11). There was no difference between patients with UA and the non-ACS group (HR 0.64; CI 0.26–1.58), and myocardial revascularization was associated with reduced mortality risk (HR 0.45; CI 0.22–0.92). Conclusions A high prevalence of ACS was found among octogenarians admitted to the ED with chest pain, and the ACS type behaved as an independent predictor of mortality. Patients with UA diagnosis had a similar prognosis to patients with non-ACS chest pain, but this needs to be demonstrated by a prospective study. Keywords Acute coronary syndrome · Chest pain · Myocardial infarction · Octogenarians · Mortality
Introduction Coronary arterial disease (CAD) incidence increases proportionally to age [1], and chest pain is a common presenting complaint in Emergency Departments (EDs). As such, an increase in the number of geriatric patients with acute coronary syndrome (ACS) in EDs is expected [2]. Diagnosing ACS in elderly patients with chest pain is a difficult task * James Samir Díaz‑Betancur [email protected] 1
Instituto de Enfermedades Cardiovasculares, Auna Clínica Las Américas, Diag 75B No. 2 A, 80/140, Medellin, Colombia
2
Unidad de Cuidado Especial Cardiovascular, Auna Clínica Las Américas, Medellín, Colombia
3
Laboratorio Clínico, Auna Clínica Las Américas, Medellín, Colombia
4
Universidad de Antioquia, Medellín, Colombia
because they may not present with pathognomonic symptoms [3, 4], leading to a late diagnosis with a greater possibility of adverse outcomes [5]. Conversely, age is one of the most important predictors of mortality in patients with ACS [6]: elderly patients frequently have a greater number of comorbidities and a lower probability of rec
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