Acute Coronary Syndrome In Elderly – The Difference Compared With Young In Intensive Care Unit Of A Tertiary Hospital In Western Nepal
1289-1296
Correspondence
Dr.Raju Paudel,MD,Lecturer,Dept of Medicine.Manipal Teaching Hospital/Manipal College of Medical Sciences Pokhara,(Nepal).E-mail:paudelraju@yahoo.com Phone: +977-61 526416 Extn:117/221
Introduction: Acute coronary syndrome (ACS), one of the commonest causes of intensive care unit (ICU) admission, casts a large burden of cost on the health care system, along with a huge mortality in the elderly population.
Objectives: This study determined the difference in presentation, complication, management and outcome in elderly patients with acute coronary syndrome, as compared to the young patients.
Material And Methods: Records of all patients who were diagnosed to have acute coronary syndrome, admitted to the ICU in the Manipal Teaching Hospital in the month of March 2006 to June 2007, was entered in a designated Proforma. Demographic details, clinical findings, treatment and complications were recorded. A total of 153 patients were analyzed and elderly patients (≥ 65 yrs) were compared with young patients (< 65yrs) using SPSS-10.0 software.
Results: Elderly patients constituted 51% (78) of the study population, among which 46.2% (36) were females. 7.7% (6) elderly patients presented with atypical symptoms, among which syncope was the commonest. Young patients were more likely to be hypertensive as compared to the elderly patients (70.7% vs. 39.7%; p<0.001). The median time of presentation to the hospital after chest pain was comparable in the two groups: 16 hours overall, but in cases of STEMI, elderly patients were brought to the hospital comparatively late, with a median time of 15 hours (IQ 5.5 – 72 as compared to young individuals in which median time was 7.25 hours (IQ 2.87 – 39 hours), which was statistically significant (p=0.000). Non ST elevated myocardial infarction (NSTEMI) and ST elevated myocardial infarction (STEMI) were similar in distribution among the elderly and young patients. Complication was seen predominantly among the elderly, with 62.8 %( 49) Vs38.7% (29); p =0.03. Overall, heart failure was the commonest complication (28.2%), followed closely by arrhythmias (26.9%). Cardiogenic shock complicating STEMI resulted in high patient mortality in both the age groups. Thrombolysed patients were similar in distribution in both groups. But the success rate of thrombolysis was lower in elderly patients (50%) as compared to young patients (76.9%). Beta blockers were less commonly used in the elderly- 47.4% (34) than in young patients- 61.3% (46). A combination of aspirin and clopidogrel was also less commonly used in the elderly patients {60.3% (47) Vs 76% (57); p=0.03}. Mortality was higher in the elderly patients (24.4% Vs 10.7%; p =0.03)
Conclusion: Elderly patients are more prone to complications, have less success rate for thrombolysis and have a higher mortality rate as compared to young patients of ACS.