Acute coronary syndromes and the elderly patient in the emergency department setting.

摘要

Objectives. We sought to describe the evaluation and outcomes of elderly patients with suspected acute coronary syndromes (ACS) presenting to the emergency department (ED).; Methods. This was a post hoc analysis of the i*trACS registry. First visits from the United States who did not use cocaine or amphetamines, or did not leave the emergency department against medical advice were included. Elderly was defined as age greater than or equal to 75 years old. Multivariable logistic regression analyses were performed to determine the association between being elderly and (1) 30-day all-cause mortality, (2) ACS, (4) diagnostic tests ordered, and (5) disposition. Multivariable logistic regression using two-factor interactions with elderly was also performed to determine which clinical variables were associated with ACS in elderly and non-elderly patients.; Results. 11,799 patients with suspected ACS presenting to the ED were analyzed. For patients presenting to the ED, being elderly was independently associated with ACS and all-cause 30-day mortality with adjusted ORs of 1.89 (95%CI 1.61--2.23) and 2.09 (95%CI 1.39--3.16), respectively. Elderly patients were more likely to be admitted to the hospital (adjusted OR = 2.21, 95%CI 1.91--2.55), but there were no differences in the rates of cardiac catheterization and non-invasive stress cardiac imaging. Multivariable logistic regression was performed to determine which clinical variables were associated with ACS. Left or substernal chest pain, previous history of coronary disease, congestive heart failure, and family history significantly interacted with being elderly.; Conclusions. Elderly patients who present to the ED with suspected ACS represent a population at high risk for ACS and 30-day mortality. Elderly patients are more likely to be admitted to the hospital, but despite an increased risk for adverse events, they have similar odds of receiving a diagnostic test such as stress cardiac imaging or cardiac catheterization compared to non-elderly patients. Different clinical variables are associated with ACS, and clinical prediction rules utilizing presenting symptoms should consider the effect modification of age.