The impact of aging on acute coronary syndromes: an EHR-based analysis.

INTRODUCTION: The number of octo and nonagenarians presenting with acute coronary syndrome (ACS) is rising and underreported. Therefore, this study aims to clarify patient characteristics and compare outcomes of an initial invasive strategy versus optimal medical treatment. METHODS: All consecutive ACS patients from 2020 until 2023 were admitted, and with EHR data extracted. Multi-variation analyses were carried out in three age groups: 80-84, 85-89 and 90+. RESULTS: A total of 1,036 consecutive patients over 80 years old were analyzed. A predominance of women, lower rates of angiography/PCI and hypercholesterolemia were observed in the nonagenarians. CABG was only performed in the 80-84 yrs group. No differences in the complication rates (type 3a bleeding, CVA, or secondary ICU admission) between the invasive and OMT group at any age. At 3 months, a trend towards a better outcome in all-cause mortality was seen in the invasive group in the age groups: 80-84: HR 0.44 (0.19-1.04) (p = 0.06), 85-89: HR 0.46 (0.20-1.07) (p = 0.07) and significant better in 90+: HR 0.16 (0.03-0.85) (p = 0.03). CONCLUSION: In this consecutive cohort of 6,168 ACS patients, 1,036 (17%) were octo- and nonagenarians. Nonagenarians differ compared to 80+ and 85+ patients. At 30 days, mortality rates were 4% in the 80-84 group, 10% in the 85-89 group (p = < 0.001), and 15% in the nonagenarians (p < 0.001). This all-comer single-center study shows that appropriate selection may be feasible for an invasive strategy in ACS octo and nonagenarians in terms of safety and outcome.