Aims: Age is one of the most powerful determinants of prognosis in myocardial infarction, but there is comparatively little recent data across the whole spectrum of acute coronary syndromes(ACS). We examined the impac...Aims: Age is one of the most powerful determinants of prognosis in myocardial infarction, but there is comparatively little recent data across the whole spectrum of acute coronary syndromes(ACS). We examined the impact of increasing age on clinical presentation and hospital outcome in a large sample of patients with ACS. Methods and results: Patients(n=10 253) from the Euroheart ACS survey in 103 hospitals in 25 countries were investigated. There was a significant inverse association between the age and the likelihood of presenting with ST-elevation. For each decade of life, the odds of presenting with ST-elevation decreased by 0.82 [95% confidence interval(CI) 0.79-0.84];P< 0.0001. Elderly patients were considerably less often treated by cardiologists, less extensively investigated, and, when presenting with ST-elevation ACS, less likely to be treated with reperfusion. Compared with patients< 55 years, the odds ratios of hospital mortality were 1.87(1.21-2.88) at age 55-64, 3.70(2.51-5.44) at age 65-74, 6.23(4.25-9.14) at age 75-84, and 14.5(9.47-22.1)among patients ≥ 85 years, with no major differences across different types of admission or discharge diagnoses. Conclusion: Elderly ACS patients were less likely to present with ST-elevation but had substantial in-hospital mortality, yet they were markedly less intensively treated and investigated.展开更多
Objective: To investigate the hypothesis that risk factors may be differently related to severity of acute coronary syndromes(ACS), with ST elevation used as a marker of severe ACS. Design: Cross sectional study of pa...Objective: To investigate the hypothesis that risk factors may be differently related to severity of acute coronary syndromes(ACS), with ST elevation used as a marker of severe ACS. Design: Cross sectional study of patients with ACS. Setting: 103 hospitals in 25 countries in Europe and the Mediterranean basin. Patients: 10 253 patients with a discharge diagnosis of ACS in the Euro heart survey of ACS.Main outcome measures: Presenting with ST elevation ACS. Results: Patients with ACS who were smokers had an increased risk to present with ST elevation(age adjusted odds ratio(OR) 1.84, 95%confidence interval(CI) 1.67 to 2.02). Hypertension(OR 0.65, 95%CI 0.60 to 0.70) and high body mass index(BMI)(p for trend 0.0005) were associated with less ST elevation ACS. Diabetes mellitus was also associated with less ST elevation, but only among men. Prior disease(infarction, chronic angina, revascularisation) and treatment with aspirin, βblockers, or statins before admission were also associated with less ST elevation. After adjustment for age, sex, prior disease, and prior medication, smoking was still significantly associated with increased risk of ST elevation(OR 1.53, 95%CI 1.38 to 1.69), whereas hypertension was associated with reduced risk(OR 0.75, 95%CI 0.69 to 0.82). Obesity(BMI>30 kg/m2 versus< 25 kg/m2)was independently associated with less risk of presenting with ST elevation among women, but not among men. Conclusion: Among patients with ACS, presenting with ST elevation is strongly associated with smoking, whereas hypertension and high BMI(in women) are associated with less ST elevation, independently of prior disease and medication.展开更多
文摘Aims: Age is one of the most powerful determinants of prognosis in myocardial infarction, but there is comparatively little recent data across the whole spectrum of acute coronary syndromes(ACS). We examined the impact of increasing age on clinical presentation and hospital outcome in a large sample of patients with ACS. Methods and results: Patients(n=10 253) from the Euroheart ACS survey in 103 hospitals in 25 countries were investigated. There was a significant inverse association between the age and the likelihood of presenting with ST-elevation. For each decade of life, the odds of presenting with ST-elevation decreased by 0.82 [95% confidence interval(CI) 0.79-0.84];P< 0.0001. Elderly patients were considerably less often treated by cardiologists, less extensively investigated, and, when presenting with ST-elevation ACS, less likely to be treated with reperfusion. Compared with patients< 55 years, the odds ratios of hospital mortality were 1.87(1.21-2.88) at age 55-64, 3.70(2.51-5.44) at age 65-74, 6.23(4.25-9.14) at age 75-84, and 14.5(9.47-22.1)among patients ≥ 85 years, with no major differences across different types of admission or discharge diagnoses. Conclusion: Elderly ACS patients were less likely to present with ST-elevation but had substantial in-hospital mortality, yet they were markedly less intensively treated and investigated.
文摘Objective: To investigate the hypothesis that risk factors may be differently related to severity of acute coronary syndromes(ACS), with ST elevation used as a marker of severe ACS. Design: Cross sectional study of patients with ACS. Setting: 103 hospitals in 25 countries in Europe and the Mediterranean basin. Patients: 10 253 patients with a discharge diagnosis of ACS in the Euro heart survey of ACS.Main outcome measures: Presenting with ST elevation ACS. Results: Patients with ACS who were smokers had an increased risk to present with ST elevation(age adjusted odds ratio(OR) 1.84, 95%confidence interval(CI) 1.67 to 2.02). Hypertension(OR 0.65, 95%CI 0.60 to 0.70) and high body mass index(BMI)(p for trend 0.0005) were associated with less ST elevation ACS. Diabetes mellitus was also associated with less ST elevation, but only among men. Prior disease(infarction, chronic angina, revascularisation) and treatment with aspirin, βblockers, or statins before admission were also associated with less ST elevation. After adjustment for age, sex, prior disease, and prior medication, smoking was still significantly associated with increased risk of ST elevation(OR 1.53, 95%CI 1.38 to 1.69), whereas hypertension was associated with reduced risk(OR 0.75, 95%CI 0.69 to 0.82). Obesity(BMI>30 kg/m2 versus< 25 kg/m2)was independently associated with less risk of presenting with ST elevation among women, but not among men. Conclusion: Among patients with ACS, presenting with ST elevation is strongly associated with smoking, whereas hypertension and high BMI(in women) are associated with less ST elevation, independently of prior disease and medication.
