Management of unstable angina: Advanced age is an independent predictor ofconservative management even after risk stratification with exercise test

Background and objective. In the management of ischemic heart disease, elde rly patients constitute a subgroup that, despite having a worse prognosis, are usually managed more conservatively. The objective of this study was to evaluate if, in the management of unstable angina, a more conservative att itude in elderly patients is maintained after stratification by exercise te st. Patients and methods. The study population is constitude by 859 patients ad mitted to hospital due to suspected unstable angina that were referred to e xercise test after medical stabilization. The management (invasive versus c onservative, according to submission to cardiac catheterization or not) of patients was retrospectively studied, comparing patients less than or equal to 70 versus > 70 years-of age. Results. Out of the 859 patients, 156 (18%) were > 70 years old, and the ex ercise test was positive in 281 (33%). Cardiac catheterization was performe d in 494 (57%): 62% in older and 38% in younger patients (p < 0.0001). Othe r characteristics associated with a more conservative management were: a ne gative exercise test, > 85% of the maximum heart rate, duration of exercise test more than 6 minutes, female gender, smoking and absence of episodes o f rest angina. In the multivariate analysis, the statistically significant characteristics associated with an invasive management were the result of t he exercise test (OR for positive result: 4.50; IC 95% = 2.73-7.63; p < 0.0 001), the duration of exercise (OR for greater than or equal to 6 minutes: 0.51; IC 95% = 0.29-0.88; p = 0.0177), the percentage of the maximum heart rate (OR for > 85%: 0.65; IC 95% = 0.42-0.98; p = 0.0391) and age (OR for > 70 years 0.36; IC 95% = 0.20-0.62; p = 0.0004). Conclusions. In the management of unstable angina, elderly patients constit ute a more conservatively managed subgroup even after risk stratification w ith exercise test.