As the elderly represent a substantial proportion of medical care beneficiaries, and there is limited data about age disparity in emerging countries, this study sought to investigate the impact of age on the management in patients with non-ST elevation acute coronary syndromes (NSTE-ACS). Two hundred patients with NSTE-ACS enrolled prospectively, patients’ data, pharmacotherapy, management strategy as well timing to catheterization were documented. Patients grouped into ≥ 65 years versus < 65 years; 32.5% were ≥ 65-year-old. The older group presented as high GRACE risk (Global Registry of Acute Coronary Events) (67.7% versus 15.6%). Elderly patients were less likely to be referred for catheterization compared with younger counterparts (55.4% versus 76.3%, p = 0.003). Within low risk class patients, none of the elderly versus 9.33% of younger patients were catheterized within 2 h; in the same line, none of the elderly versus 16% of younger patients were catheterized within 24 h. Alternatively, at high risk class, 6.81% of the elderly and none of the younger patients were catheterized within 2 h. On the univariate analysis of variables to predict invasive strategy, presence of history of prior IHD, diabetes, absent in-hospital acute heart failure or atrial fibrillation/flutter, higher haemoglobin and lower creatinine levels predicted the use of invasive strategy, while on multivariate analysis, acute heart failure (95% CI − 0.38 to − 0.41, p = 0.01), lower haemoglobin (95% CI 0.002–0.07, p = 0.03), and atrial fibrillation/flutter (95% CI − 0.48 to − 0.02, p = 0.03) predicted conservative strategy. The elderly were more likely to have acute heart failure (32.3% versus 14.8%, p = 0.004), same as stroke (3.1% versus none, p = 0.04). Less-invasive strategy used in the elderly with NSTE-ACS compared with younger counterparts, yet age was not a predictor of catheterization underuse on multivariate analysis. It is crucial to bridge the age gap in the healthcare system in setting of ACS management by grasping the attention of decision makers and emphasizing on the adherence of healthcare providers to the guidelines to improve cardiovascular care and outcomes.

中文翻译：

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非ST段抬高的急性冠状动脉综合征；临床前景，管理策略和院内结局：年龄观点

由于老年人占医疗受益人的很大比例，并且新兴国家的年龄差异数据有限，因此本研究旨在调查年龄对非ST段抬高急性冠脉综合征（NSTE-ACS）患者管理的影响）。前瞻性纳入了200例NSTE-ACS患者，记录了患者的数据，药物治疗，管理策略以及导管插入的时机。年龄≥65岁而小于65岁的患者；≥65岁为32.5％。老年组表现出较高的GRACE风险（急性冠脉事件全球注册）（67.7％对15.6％）。与年轻患者相比，老年患者接受导尿的可能性较小（55.4％对76.3％，p = 0.003）。在低风险类别的患者中，没有一个是老年人，而只有9个。33％的年轻患者在2小时内进行了导尿；在同一行中，在24 h内，没有老年人与16％的年轻患者进行导尿。另外，在高危人群中，有6.81％的老年人和年轻的患者均未在2小时内进行导尿。在对变量进行单因素分析以预测侵入性策略时，有先前IHD病史，糖尿病，院内急性心力衰竭或心房颤动/扑动不存在，血红蛋白较高和肌酐水平较低等因素预测了侵入性策略的使用，而在多变量分析中，急性心力衰竭（95％CI-0.38至-0.41，p = 0.01），较低的血红蛋白（95％CI 0.002-0.07，p = 0.03）和房颤/颤动（95％CI-0.48至-0.02，p = 0.03）预测的保守策略。老年人患急性心力衰竭的可能性更高（32.3％对14岁）。8％，p = 0.004），与中风相同（3.1％vs无，p = 0.04）。与较年轻的NSTE-ACS相比，NSTE-ACS的老年人使用的侵入性较小的策略，但年龄并不是多因素分析中未使用导尿管的预测指标。通过抓住决策者的注意力并强调医疗保健提供者对改善心血管护理和结局的指导方针的遵守，在设置ACS管理中弥合医疗保健系统中的年龄差距至关重要。