Nonagenarians admission and prognosis in a tertiary center intensive coronary care unit - a prospective study.

BACKGROUND: With increasing life expectancy, the prevalence of nonagenarians with cardiovascular disease is steadily growing. However, this population is underrepresented in randomized trials and thus poorly defined, with little quality evidence to support and guide optimal management. The aim of the present study was to evaluate the clinical management, therapeutic approach, and outcomes of nonagenarians admitted to a tertiary care center intensive coronary care unit (ICCU). METHODS: We prospectively collected all patients admitted to a tertiary care center ICCU between July 2019 - July 2022 and compared nonagenarians to all other patients. The primary outcome was in-hospital mortality. RESULTS: A total of 3807 patients were included in the study. Of them 178 (4.7%) were nonagenarians and 93 (52%) females. Each year the prevalence of nonagenarians has increased from 4.0% to 2019, to 4.2% in 2020, 4.6% in 2021 and 5.3% in 2022. Admission causes differed between groups, including a lower rate of acute coronary syndromes (27% vs. 48.6%, p < 0.001) and a higher rate of septic shock (4.5% vs. 1.2%, p < 0.001) in nonagenarians. Nonagenarians had more comorbidities, such as hypertension, renal failure, and atrial fibrillation (82% vs. 59.6%, 23% vs. 12.9%, 30.3% vs. 14.4% p < 0.001, respectively). Coronary intervention was the main treatment approach, although an invasive strategy was less frequent in nonagenarians in comparison to younger subjects. In-hospital mortality rate was 2-fold higher in the nonagenarians (5.6% vs. 2.5%, p = 0.025). CONCLUSION: With increasing life expectancy, the prevalence of nonagenarians in ICCU's is expected to increase. Although nonagenarian patients had more comorbidities and higher in-hospital mortality, they generally have good outcomes after admission to the ICCU. Hence, further studies to create evidence-based practices and to support and guide optimal management in these patients are warranted.

Level of Hypoalbuminemia as a Prognostic Factor in Patients admitted to a Tertiary Care Intensive Coronary Care Unit.

Introduction: Hypoalbuminemia is common in acute and chronic diseases. It has been proposed as a potential biomarker of frailty, which itself is associated with worse outcomes. However, data regarding the level of hypoalbuminemia and its prognosis in contemporary intensive coronary care unit (ICCU) patients is scarce. Materials and Methods: All patients who had albumin level on admission to an ICCU at a tertiary care center between January 1, 2020, and December 31, 2020, were included in the study. Patients were divided into 3 groups according to their albumin level on admission: low (< 3 g/dL), intermediate (3 g/dL≤ and ≤ 4 g/dL) and high albumin level (> 4 g/dL). Survival and in-hospital interventions and complications were compared. Results: Overall 1,036 consecutive patients were included, mean age was 67±16 years and 70% were males. Of them 88 (8.5%) had low, 739 (71.5%) intermediate and 209 (20%) had high albumin levels. In a multivariate cox proportional hazards analysis, low albumin level was independently associated with higher 1-year mortality rate as compared with high albumin level (HR=9.5; 95% CI: 3.2-25.5, p<0.001). Intermediate albumin level had also a trend toward higher 1-year mortality rate as compared with high albumin level (HR=2.1; 95% CI: 0.9-5.6, p=0.09). Conclusion: Hypoalbuminemia in ICCU patients is a poor prognostic factor associated with in-hospital complications and an independent risk factor for 1-year mortality rate, while intermediate albumin level shows a trend towards higher 1-year mortality rate as well.