[The impact of comorbidity in the management of octogenarians with non-ST-elevation acute coronary syndrome].

Background: Octogenarians are the fastest growing segment of our population and show a high prevalence of coronary disease. Despite these trends they are underrepresented in randomized controlled trials on acute coronary syndromes. Although older patients with acute coronary syndromes are at increased risk of death or reinfarction, they are less likely to be treated with an aggressive strategy.

Methods: In a retrospective analysis, we evaluated 176 consecutive octogenarians admitted to our Division of Cardiology with non-ST-elevation acute coronary syndrome, the causes of their exclusion from cardiac catheterization, and in particular the impact of associated comorbid conditions.

Results: Demographic characteristics, left ventricular ejection fraction and medical therapy were comparable in the groups of patients treated with a conservative or aggressive strategy. Cardiovascular risk factors and the TIMI risk score were similarly distributed between the two groups. The most important cause of exclusion from coronary angiography was the presence of comorbidity (77% of patients of this group). In order to assess the total comorbidity burden, we applied the Charlson comorbidity index to this group and found that 32% of patients excluded from aggressive strategy did not show a so severe associate disorder complexity.

Conclusions: The use of a validated index to measure associated disorders is advisable in our clinical practice to properly assess illness severity, in order to not deny an interventional procedure which could improve the quality of life of the oldest patients.