Short-term prognostic factors in elderly patients treated in emergency departments for acute coronary syndrome with ST segment elevation

Objective: To identify factors associated with short-term mortality in patients of advanced age who come to the emergency department with acute coronary syndrome with ST segment elevation. Methods: Prospective longitudinal observational multicenter analytic study without interventions. Patients aged 70 years or older who were treated at 42 Spanish hospitals were included. Seventeen independent variables that might influence 30-day mortality were analyzed. The information was extracted from the medical records or obtained during interviews with the patient or a family member; it was then recorded in a database developed for this study. Results: A total of 1137 patients were included; 340 (29.9%) died within 30 days of the emergency department visit. Four variables conferred significant risk of mortality. These were age (odds ratio [OR], 2.71; 95% confidence interval [Cl], 2.02-3.64); lack of primary angioplasty (OR, 3; 95% Cl, 1.32-6.81); advanced Killip class (OR, 10.19; 95% Cl, 6.99-14.85); and anterior location of the lesion (OR, 1.39; 95% Cl, 1.03-1.86). Conclusions: We identified several factors, such as age, that are recorded during emergency department assessment and that predict poor short-term outcome in the elderly patient treated for acute coronary syndrome with ST segment elevation. Although Killip class, location of the acute myocardial infarction, and age cannot be modified, we did identify a factor (performance of primary angioplasty) that, unlike fibrinolytic treatment, is independently associated with a better outcome in terms of 30-day mortality. [Emergencias 2011;23:455-460]