Although chest pain and acute coronary syndrome (ACS) are among the most common complaints in the Emergency Departments (ED), little is known about this topic in the octogenarian population.
This study aimed to describe the clinical presentation and to evaluate survival time according to the ACS type in a group of 80-year-old or over patients admitted for chest pain to an ED.
Patients were classified according to the discharge diagnosis. A multivariable Cox regression analysis was done to assess the association between ACS type and mortality with the non-ACS chest pain group as the reference category.
ACS was diagnosed in 170 of the 391 patients analyzed and 51% of ACS patients were female. Within the ACS patients, 18.8% presented STEMI, 57% NSTEMI, and 24% unstable angina (UA). Most of the patients were treated conservatively. In the adjusted analysis, the incidence of death at 40 months of follow-up was higher in patients with STEMI (HR 3.24; CI 1.59–6.56) than NSTEMI (HR 2.53; CI 1.56–4.11). There was no difference between patients with UA and the non-ACS group (HR 0.64; CI 0.26–1.58), and myocardial revascularization was associated with reduced mortality risk (HR 0.45; CI 0.22–0.92).
A high prevalence of ACS was found among octogenarians admitted to the ED with chest pain, and the ACS type behaved as an independent predictor of mortality. Patients with UA diagnosis had a similar prognosis to patients with non-ACS chest pain, but this needs to be demonstrated by a prospective study.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Lerner DJ, Kannel WB (1986) Patterns of coronary heart disease morbidity and mortality in the sexes: A 26-year follow-up of the Framingham population. Am Heart J 111:383–390
Madhavan MV, Gersh BJ, Alexander KP et al (2018) Coronary artery disease in patients ≥ 80 Years of age. J Am Coll Cardiol 71:2015–2040
Wilson M, Welch J, Schuur J et al (2014) Hospital and emergency department factors associated with variations in missed diagnosis and costs for patients age 65 years and older with acute myocardial infarction who present to emergency departments. Acad Emerg Med 21:1101–1108
Solomon CG, Lee TH, Cook EF et al (1989) Comparison of clinical presentation of acute myocardial infarction in patients older than 65 years of age to younger patients: the multicenter chest pain study experience. Am J Cardiol 63:772–776
Brieger D, Eagle KA, Goodman SG, White et al (2006) Chest pain, an underdiagnosed and undertreated high-risk group *. CHEST J-Am Coll Chest Physicians 125:461–469
Fox KAA, Eagle KA, Gore JM et al (2010) The global registry of acute coronary events, 1999 to 2009-GRACE. Heart 96:1095–1101
Toleva O, Ibrahim Q, Brass N et al (2015) Treatment choices in elderly patients with ST: elevation myocardial infarction—insights from the vital heart response registry. Open Hear 2:e000235
Malkin CJ, Prakash R, Chew DP (2012) The impact of increased age on outcome from a strategy of early invasive management and revascularisation in patients with acute coronary syndromes: retrospective analysis study from the ACACIA registry. BMJ Open 2:1–7
Skolnick AH, Alexander KP, Chen AY et al (2007) Characteristics, management, and outcomes of 5557 Patients Age ≥ 90 years With Acute Coronary Syndromes. Results From the CRUSADE Initiative. J Am Coll Cardiol 49:1790–1797
Alexander KP, Chen AY, Roe MT et al (2005) Excess dosing of antiplatelet and antithrombin agents in the treatment of non-ST-segment elevation acute coronary syndromes. J Am Med Assoc 294:3108–3116
Hochman JS, Tamis JE, Thompson TD et al (1999) Sex, Clinical presentation, and outcome in patients with acute coronary syndromes. Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes IIb Investigators. N Engl J Med 341:226–232
Alexander KP, Newby LK, Cannon CP et al (2007) 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. Circulation. 115:2549–2569
Wiviott SD, Braunwald E, McCabe CH et al (2007) Prasugrel versus Clopidogrel in Patients with Acute Coronary Syndromes. N Engl J Med 357:2001–2015
Wallentin L, Becker RC, Budaj A et al (2009) Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes. N Engl J Med 361:1045–1057
Madsen TE, Fuller M, Hartsell S et al (2016) Prospective evaluation of outcomes among geriatric chest pain patients in an ED observation unit. Am J Emerg Med 34:207–211
Jneid H, Fonarow GC, Cannon CP et al (2008) Sex differences in medical care and early death after acute myocardial infarction. Circulation 118:2803–2810
Maynard C, Litwin PE, Martin JS, Weaver WD (1992) Gender differences in the treatment and outcome of acute myocardial infarction: results from the myocardial infarction triage and intervention registry. Arch Intern Med 152:972–976
Chiriboga DE, Yarzebski J, Goldberg RJ et al (1993) A community-wide perspective of gender differences and temporal trends in the use of diagnostic and revascularization procedures for acute myocardial infarction. Am J Cardiol 71:268–273
Fiebach NH, Viscoli CM, Horwitz RI (1990) Differences between women and men in survival after myocardial infarction: biology or methodology? JAMA J Am Med Assoc 263:1092–1096
Robinson K, Conroy RM, Mulcahy R (1988) Risk factors and in-hospital course of first episode of myocardial infarction or acute coronary insufficiency in women. J Am Coll Cardiol 11:932–936
Kostis JB, Wilson AC, O’Dowd K et al. (1994) Sex differences in the management and long-term outcome of acute myocardial infarction: a statewide study. Circulation. 90:1715–30.
Clarke KW, Gray D, Keating NA et al (1994) Do women with acute myocardial infarction receive the same treatment as men? BMJ 309:563
Greenland; P, Reicher-Reiss H, Goldbourt et al. (1991) In-hospital and 1-year mortality in 1, 524 women after myocardial infarction. Circulation. 83:484–91.
Bauer T, Koeth O, Jünger C et al (2007) Effect of an invasive strategy on in-hospital outcome in elderly patients with non-ST-elevation myocardial infarction. Eur Heart J 28:2873–2878
Jaguszewski M, Ghadri JR, Diekmann J et al (2014) Acute coronary syndromes in octogenarians referred for invasive evaluation: treatment profile and outcomes. Clin Res Cardiol 104:51–58
Bueno H, Betriu A, Heras M et al. (2011) Primary angioplasty vs. fibrinolysis in very old patients with acute myocardial infarction: TRIANA (TRatamiento del Infarto Agudo de miocardio en Ancianos) randomized trial and pooled analysis with previous studies. Eur Heart J. 32:51–60.
Devlin G, Gore JM, Elliott J et al (2008) Management and 6-month outcomes in elderly and very elderly patients with high-risk non-ST-elevation acute coronary syndromes: the global registry of acute coronary events. Eur Heart J 29:1275–1282
Saunderson CED, Brogan RA, Simms AD et al (2014) Acute coronary syndrome management in older adults: Guidelines, temporal changes and challenges. Age Ageing 43:450–455
Mehta RH, Rathore SS, Radford MJ et al (2001) Acute myocardial infarction in the elderly: differences by age. J Am Coll Cardiol 38:736–741
Amsterdam EA, Kirk JD, Bluemke DA et al (2010) Testing of low-risk patients presenting to the emergency department with chest pain: a scientific statement from the American Heart Association. Circulation 122:1756–1776
Regitz-Zagrosek V, Oertelt-Prigione S, Prescott E et al (2016) Gender in cardiovascular diseases: impact on clinical manifestations, management, and outcomes. Eur Heart J 37:24–34
Vandecasteele EH, De Buyzere M, Gevaert S et al (2013) Reperfusion therapy and mortality in octogenarian STEMI patients: results from the Belgian STEMI registry. Clin Res Cardiol 102:837–845
Haase KK, Schiele R, Wagner S et al (2000) In-hospital mortality of elderly patients with acute myocardial infarction: data from the mitra (Maximal individual therapy in acute myocardial infarction) registry. Clin Cardiol 23:831–836
Alexander KP, Newby LK, Armstrong PW et al (2007) Acute coronary care in the elderly, part II: ST-segment-elevation myocardial infarction: a scientific statement for healthcare professionals from the American heart association council on clinical cardiology. Circulation 115:2570–2589
Fox KAA, Clayton TC, Damman P et al (2010) Long-term outcome of a routine versus selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome. A meta-analysis of individual patient data. J Am Coll Cardiol 55:2435–2445
Bach RG, Cannon CP, Weintraub WS (2004) The effect of routine, early invasive management on outcome for elderly patients with non-ST-segment elevation acute coronary syndromes. ACC Curr J Rev 13:53–54
Saraswat A, Rahman A, Singh K (2018) An invasive vs a conservative approach in elderly patients with non-ST-segment elevation myocardial infarction: systematic review and meta-analysis. Can J Cardiol 34:274–280
Savonitto S, Cavallini C, Petronio AS et al (2012) Early aggressive versus initially conservative treatment in elderly patients with non–ST-segment elevation acute coronary syndrome: a randomized controlled trial. JACC Cardiovasc Interv 5:906–916
Tegn N, Abdelnoor M, Aaberge L et al (2016) Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (After Eighty study): an open-label randomised controlled trial. Lancet 387:1057–1065
Pemberthy-López C, Jaramillo-Gómez N, Cardona-Vélez J et al (2016) Estratificación de riesgo para enfermedad coronaria en adultos mayores. Rev Colomb Cardiol 23:286–292
Afilalo J, Alexander KP, Mack MJ et al (2014) Frailty assessment in the cardiovascular care of older adults. J Am Coll Cardiol 63:747–762
Ekerstad N, Swahn E, Janzon M et al (2011) Frailty is independently associated with short-term outcomes for elderly patients with non-ST-segment elevation myocardial infarction. Circulation 124:2397–2404
Sampson JJ, Eliaser M (1937) The diagnosis of impending acute coronary artery occlusion. Am Heart J 13:675–686
Feil H (1937) Preliminary pain in coronary thrombosis. Am J Med Sci 193:42–47
Bonaca M, Scirica B, Sabatine M et al (2010) Prospective evaluation of the prognostic implications of improved assay performance with a sensitive assay for cardiac troponin I. J Am Coll Cardiol 55:2118–2124
Mills NL, Churchhouse AMD, Lee KK et al (2011) Implementation of a sensitive troponin I assay and risk of recurrent myocardial infarction and death in patients with suspected acute coronary syndrome. JAMA 305:1210–1216
Mahmoud O, Mahmaljy H, Youniss M et al. (2020) Comparative outcome analysis of stable mildly elevated high sensitivity troponin T in patients presenting with chest pain. A single-center retrospective cohort study. IJC Hear Vasc 30:100586
Braunwald E, Morrow DA (2013) Unstable angina is it time for a requiem? Circulation 127:2452–2456
We are grateful to the non-invasive cardiology service, the hemodynamic laboratory, and the clinical laboratory of Auna Clínica las Américas.
Not applicable. This work was supported by the authors' own resources. We did not receive grants, contracts or other forms of financial support.
Conflict of interest
Not applicable. On behalf of all the authors, the corresponding author states that there is no conflict of interest.
The study protocol was classified as a risk-free investigation and approved by the Institutional Research Ethics Committee.
Consent to participate
Not applicable. This was a retrospective study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Díaz-Betancur, J.S., Martínez, J., Zapata, J. et al. Chest pain and acute coronary syndrome in octogenarians admitted to the Emergency Department. Aging Clin Exp Res (2020). https://doi.org/10.1007/s40520-020-01737-3
- Acute coronary syndrome
- Chest pain
- Myocardial infarction