Are there specific prognostic factors for acute coronary syndrome in patients over 80 years of age?

PURPOSE: In elderly patients, the prognosis of acute coronary syndrome is bleak and the impact of geriatric factors is as yet unknown. The purpose of this work was to identify factors predictive of poor outcome at Month 6 in a population of elderly subjects admitted into hospital with acute coronary syndrome. MATERIALS AND METHODS: One hundred and thirty-two patients over 80 years of age were compared with 127 patients under 80, all admitted into a cardiology intensive care unit with acute coronary syndrome between May 2006 and January 2007, vis-à-vis outcome, mortality and cardiovascular events, both during the hospital stay and six months later. RESULTS: Coronary angiography was performed in fewer of the over-80 group (85.6% versus 97.7%, p<0.001) but revascularisation rates were comparable in both groups (75.6% versus 78.9%, p=0.58). During the hospital stay, the incidence of complications was higher (68.8% versus 38.1%, p<0.0001) in the older patients as was mortality (18.2% versus 3.2%, p=0.0001). At Month 6, all-cause mortality was higher in the octogenarians (28.0% versus 10.6%, p<0.001). The independent variables associated with Month 6 all-cause mortality in the over-80 group were: systolic blood pressure of less than 100mmHg, an admission heart rate of over 100bpm, a history of cardiovascular disease, acute coronary syndrome with ST segment elevation in the anterior territory, and the absence of chest pain. CONCLUSION: In elderly patients admitted into hospital with acute coronary syndrome, geriatric parameters do not seem to affect prognosis which is dominated by cardiac variables.

Prevalence of typical atrial flutter with reentry circuit posterior to the superior vena cava: use of entrainment at the atrial roof.

AIMS: Upper turn-around of the reentry circuit in typical atrial flutter (AF) is classically described to be located in front of the superior vena cava (SVC), but circuits posterior to the SVC as well as lower loop reentry (LLR) involving only the lower part of the right atrium have been described. However, true prevalence of such AF circuits remains unknown. METHODS AND RESULTS: Fifty consecutive patients (46 men, 68 +/- 9 years old) undergoing radiofrequency (RF) ablation of typical counter-clockwise AF were prospectively investigated. Prior to RF deliverance, AF was entrained by pacing 10 ms shorter than the AF cycle length (AFCL). Post-pacing interval (PPI) at the cavotricuspid isthmus (CTI) and at the atrial roof (AR)-between SVC and the high tricuspid annulus-were determined. AR was considered to be part of the AF circuit when local PPI-AFCL was < or =20 or 30 ms or, in case of long PPI at the CTI isthmus, if difference between AR-PPI and CT-PPI was < or =10 ms. In 47 patients, CTI-PPI-AFCL was < or =30 ms (94%). Among them, AR-PPI-AFCL was >30 ms in 12 cases (25%). In the remaining three patients, AR-PPI-AFCL did not exceed CTI-PPI-AFCL by more than 10 ms. In 42 patients, CTI-PPI-AFCL was < or =20 ms (84%). Among them, AR-PPI-AFCL was >20 ms in 16 cases (39%). In the remaining eight patients, AR-PPI-AFCL was more than 10 ms longer than CTI-PPI-AFCL in only one instance. Taken together, AR PPI was >20 or >30 ms longer than AFCL or >10 ms longer than CTI PPI when prolonged in 17 (34%) and 12 patients (24%), respectively. CONCLUSION: In around a quarter to one-third of patients referred for RF ablation of typical AF, the atrial roof is not part of the circuit, thus they may present a 'posterior' variant of the typical counter-clockwise AF reentry circuit.