Early invasive strategy in elderly patients with non-ST elevation acute coronary syndrome: comparison with younger patients regarding 30 day and long term outcome.

OBJECTIVES: To evaluate an early invasive strategy in elderly patients with non-ST elevation acute coronary syndrome (ACS). METHODS: All consecutive patients admitted with a diagnosis of non-ST elevation ACS from June 2002 to February 2004 were enrolled in this registry. Clinical outcome was assessed at 30 days and in long term follow up. RESULTS: An early invasive strategy was followed for 439 patients, of whom 159 (36%) were elderly and had a higher clinical risk profile and greater extent of coronary artery disease (CAD) than the younger patients. Coronary revascularisation was conducted in 133 (83%) elderly patients and 239 (85%) younger patients (not significant). At a mean (SD) follow up time of 10.7 (5.2) months overall mortality, cardiac death, and death plus myocardial infarction were significantly higher among elderly patients than among younger patients (9.4% v 2.1%, p < 0.001; 6.8% v 1.8%, p < 0.01; 11.3% v 5%, p = 0.02, respectively). The significant difference in cardiac death between the two groups was related more to elderly patients being treated by coronary artery bypass grafting (19.3% v 4.9%, p = 0.05) than by percutaneous coronary intervention (PCI) (2.9% v 1.1%, p = 0.3). Cox regression analysis showed age, serum creatinine > 115 micromol/l, no previous history of CAD, left ventricular ejection fraction > 45%, and the absence of diabetes to be independent predictors of the occurrence of major adverse cardiac events. CONCLUSIONS: In unselected elderly patients presenting with non-ST elevation ACS an early invasive strategy is feasible and leads to coronary revascularisation in the majority of cases, resulting in encouraging immediate and long term clinical results, particularly among PCI treated patients.

[Rupture of the interventricular septum in lower myocardial infarction with asymptomatic onset]. / Rottura del setto interventricolare in infarto miocardico inferiore ad esordio asintomatico.

We report the case of a 69-year-old patient with no history of cardiac problems referred to us for dyspnea. A major systolic murmur was found and the echocardiogram revealed an interventricular septal defect. The ECG showed no signs of acute myocardial infarction that was established on the basis of myocardial enzymes. The patient was hemodynamically stabilized by intra-aortic balloon pumping. A later coronarography revealed one-vessel coronary artery disease. Then the patient underwent successful surgical repair of the septal defect.