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Publications

Journal Article Ahead of print

PubMed: 42026687 DOI: 10.1002/ccd.70635

Gender Differences in Risk Factors, Management, and Outcomes of Elderly Patients With Acute Coronary Syndrome: The Interplay of Frailty.

Catheter Cardiovasc Interv

Authors: Sabiye Yılmaz, Murat Uğur, Saadet D İnci, Kahraman Coşansu, Muhsin O Çelik, Hasan Döner, Samet Solmaz, Yunus Koç, Kenan Çayır, Burak Turhan, Ahmet B Duman, Büşra Sağdıç, Furkan Gençer, Mutlu C Kabacı, Samet Geçer, Emine B Kıtlık, Burak Turan, Ayhan Erkol

Affiliations

  • Department of Cardiology, Health Sciences University, Kocaeli City Hospital Kocaeli, Kocaeli, Türkiye.
  • Department of Cardiology, Kocaeli City Hospital, Kocaeli, Türkiye.
  • Department of Cardiology, Ankara Etlik City Hospital, Ankara, Türkiye.
  • Department of Cardiology, Türkiye Hospital, İstanbul, Türkiye.

Abstract

BACKGROUNDS

Older adults constitute a growing proportion of patients presenting with acute coronary syndrome (ACS); optimal management remains uncertain due to comorbidities, frailty, procedure-related complications.

AIM

This study aimed to identify prognostic determinants and to evaluate the impact of invasive management strategies on short- and long-term outcomes in elderly patients with ACS.

METHODS

We retrospectively analyzed consecutive ACS patients aged ≥ 75 years who underwent coronary angiography. Frailty was assessed within the first 48 h of admission using the Rockwood Clinical Frailty Scale (CFS). Sex-related differences, frailty, treatment strategies (percutaneous coronary intervention [PCI] vs. conservative/medical therapy), predictors of short- and long-term outcomes were assessed. The primary endpoint was all-cause mortality; secondary endpoints included major adverse cardiac and cerebrovascular events (MACCEs).

RESULTS

A total of 627 patients were included (46% women), with non-ST-elevation ACS (NSTE-ACS) as the predominant presentation (66.8%). Patients presenting with ST-elevation myocardial infarction (STEMI) experienced significantly higher in-hospital mortality (19.7% vs.5.7%) and MACCEs rates (50.5% vs. 22%; both p < 0.001) compared with those with NSTE-ACS. In-hospital and 1-year mortality did not differ by sex. Shock, frailty, contrast-induced nephropathy, peak troponin levels as independent predictors of in-hospital mortality, whereas frailty, reduced left ventricular ejection fraction, peak troponin independently predicted long-term mortality. Among patients with NSTE-ACS, PCI was associated with lower in-hospital mortality (3.5% vs. 8.4%; p = 0.040) but higher rates of in-hospital and long-term adverse events, without a significant reduction in 1-year mortality.

CONCLUSIONS

Frailty is a dominant determinant of both short- and long-term mortality and should be systematically incorporated into early risk stratification. A selective, frailty-guided invasive strategy may improve early survival whereas routine intervention appears unjustified given the lack of long-term benefit and increased complication risk.

MeSH

Mortality, Troponin, Percutaneous Coronary Intervention, Hospital Mortality, Cardiac Catheterization, Acute Coronary Syndrome, Aged, St Elevation Myocardial Infarction, Sex Characteristics, Sex, Risk Factors, Therapeutics, Frailty, Sex Differences