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Short-term prognostic factors in elderly patients treated in emergency departments for acute coronary syndrome with ST segment elevation

Montiel Dacosta JA, Santaló I Bel M, Balaguer Martínez JV, Temboury Ruiz F, Povar Marco J, Gich Saladich I

Servicio de Urgencias. Hospital de la Santa Cruz y San Pablo. Barcelona, Spain. Servicio de Urgencias. Hospital Clínico de Valencia. Spain. Servicio de Urgencias. Hospital Clínico Universitario Virgen de la Victoria. Málaga, Spain. Servicio de Urgencias.

Objective: To identify factors associated with short-term mortality in patients of
advanced age who come to the emergency department with acute coronary syndrome
with ST segment elevation.
Methods: Prospective longitudinal observational multicenter analytic study without
interventions. Patients aged 70 years or older who were treated at 42 Spanish hospitals
were included. Seventeen independent variables that might influence 30-day mortality
were analyzed. The information was extracted from the medical records or obtained
during interviews with the patient or a family member; it was then recorded in a
database developed for this study.
Results: A total of 1137 patients were included; 340 (29.9%) died within 30 days of the
emergency department visit. Four variables conferred significant risk of mortality. These
were age (odds ratio [OR], 2.71; 95% confidence interval [CI], 2.02-3.64); lack of
primary angioplasty (OR, 3; 95% CI, 1.32-6.81); advanced Killip class (OR, 10.19; 95%
CI, 6.99-14.85); and anterior location of the lesion (OR, 1.39; 95% CI, 1.03-1.86).
Conclusions: We identified several factors, such as age, that are recorded during
emergency department assessment and that predict poor short-term outcome in the
elderly patient treated for acute coronary syndrome with ST segment elevation.
Although Killip class, location of the acute myocardial infarction, and age cannot be
modified, we did identify a factor (performance of primary angioplasty) that, unlike
fibrinolytic treatment, is independently associated with a better outcome in terms of 30-
day mortality.

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