Influence of Proven Oral Therapies in the Very Old with Acute Coronary Syndromes: A 15year Experience

Over the past 15 years, there has been a major progress in the management of acute coronary syndromes' (ACS) population. During this period, the use of dual antiplatelet therapy, statins, beta-blockers and angiotensin-converting enzyme (ACE) inhibitors/angiotensin II type-1 (AT1) receptor blockers, was shown to improve outcomes in ACS population [ 1 O'Gara P.T. Kushner F.G. Ascheim D.D. et al. ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J. Am. Coll. Cardiol. 2013; 61: e78-e140 Abstract Full Text Full Text PDF PubMed Scopus (2434) Google Scholar , 2 Nicolau J.C. Timerman A. Marin-Neto J.A. et al. Guidelines of Sociedade Brasileira de Cardiologia for unstable angina and non-ST-segment elevation myocardial infarction (II edition, 2007) 2013–2014 update. Arq. Bras. Cardiol. 2014; 102: 1-61 PubMed Google Scholar ]. Additionally, advances in percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG) also contributed significantly to the decrease in morbidity and mortality [ 3 Venkitachalam L. Kip K.E. Selzer F. et al. Twenty-year evolution of percutaneous coronary intervention and its impact on clinical outcomes: a report from the National Heart, Lung, and Blood Institute-sponsored, multicenter 1985–1986 PTCA and 1997–2006 dynamic registries. Circ. Cardiovasc. Interv. 2009; 2: 6-13 Crossref PubMed Scopus (66) Google Scholar , 4 Head S.J. Kieser T.M. Falk V. Huysmans H.A. Kappetein A.P. Coronary artery bypass grafting: part 1—the evolution over the first 50 years. Eur. Heart J. 2013; 34 (286–72) Google Scholar ]. Although the elderly represent a growing proportion of ACS patients, older patients are underrepresented in large clinical trials. Moreover, those included generally have fewer traditional cardiovascular risk factors, less comorbidities, and better hemodynamics and renal function when compared to individuals of similar age described in community registries [ [5] Alexander K.P. Newby L.K. Cannon C.P. et al. Acute coronary care in the elderly, part I: non-ST-segment-elevation acute coronary syndromes: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Ger. Circulation. 2007; 115: 2549-2569 Crossref PubMed Scopus (593) Google Scholar ]. Finally, despite a higher risk profile, elderly patients in the community continue to demonstrate less frequent use of cardiac medications and invasive care [ [6] Nicolau J.C. Lemos P.A. Wajngarten M. et al. The role of invasive therapies in elderly patients with acute myocardial infarction. Clinics. 2009; 64 (Sao Paulo): 553-560 Crossref PubMed Scopus (9) Google Scholar ]. The main objectives of this report are to assess changes in the treatment of ACS over a 15 year timespan, and the impact of these changes in “young” (≤50 years) and “very old” (≥80 years) patients.