Unstable angina in the elderly: Clinical, profile, management and mortality at three months. The PEPA registry data

Introduction and objectives. Few reports in the literature have studied the characteristics and management of unstable angina in the elderly in Spain. The aim of this study was to analyze the clinical characteristics and the use of diagnostic and therapeutic resources in patients greater than or equ al to 70 years of age. Patients and methods. A total of 1,551 patients greater than or equal to 70 years of age were included out of 4,115 included in the PEPA registry with a follow up of 90 days. These patients were compared with 2,564 < 70 years . Results. in comparison, the elderly (76 +/- 5 years) versus the younger gro up (58 +/- 8.5 years) included a higher proportion of women (43 vs 27%), di abetics (30 vs 23%) and hypertensive patients (60 vs 49%) with a lower prop ortion (p < 0.001) of hypercholesterolemia (33 vs 43%), smoking (40 vs 60%) or family history (9 vs 17%). A previous history of angina (49 vs 35%) or infarction (38 vs 31%) and co-morbidity was found to be significantly more frequent in the elderly, with a worse previous functional class (NYHA > 2 o ut of 34 vs 15%). The elderly were treated with fewer invasive procedures ( 25 vs 44%) or catheterization (26 vs 36%) and they were more frequently con trolled with medical treatment (86 vs 83%) although with a lower use of bet a-blockers (45 vs 53%). The mortality at 3 months was greater in the elderl y (7.4 vs 3.0%; p < 0.005) with age being an independent predictor of bad p rognosis. Cox multivariate analysis showed the age, ST segment depression, diabetes and heart failure on admission to be predictors of bad prognosis i n the elderly. Conclusions. A different pattern is observed in cardiovascular risk factors with a more unfavorable clinical profile in elderly patients with unstable angina. The management of these patients is less aggressive and the mortal ity is greater. Diabetes, heart failure and ST segment depression on admiss ion are independent predictors of bad prognosis in elderly patients.