Treatment of acute coronary syndrome without ST-segment elevations in the elderly

Introduction

Studies have shown the efficacy of new strategies in acute coronary syndrome without ST-segment elevations (ACSWSTE). However, its implementation does not seem satisfactory, especially in elderly patients.

Objective

To analyze the employment of the guidelines in the treatment of ACSWSTE.

Methods

We analyzed two groups of patients in the ICU – GI, <65 years old (n = 20) and GII, ≥ 65 years old (n = 34) – based on alterations in the electrocardiogram (ECG), echocardiogram and cardiac enzymes. The invasive strategy, drug therapy, medical treatment, percutaneous and surgical revascularization were also studied. The Student t test, the chi-square test, and the Fisher's exact test were employed with a significance level of 5%.

Results

The mean age was 68 ± 14 years; 61% were female. The risk factors were as follows: arterial hypertension – 76%, dislipidemia – 35%, diabetes – 32%, tobacco smoking – 24%. Around 54% had chronic coronary disease, and 24% and 22% had been previously submitted to angioplasty and revascularization surgery, respectively. On admission, 43% of the patients were under ASA therapy, 35% used AECI, 32% were under beta-blocker therapy, 28% used nitrate calcium antagonist, and 22% used statins. Hemodynamic instability and arrhythmias occurred in 6% and intensity of pain was, on average, 6 ± 2. Non-specific ECG and inversion of the T wave occurred in 41% of the patients, and infra-ST elevations (P = 0.046) occurred in 20%. A larger number of patients in GII tested positive for troponin I and they presented larger global dysfunction (P = 0.032), segmental dysfunction (P = 0.036), TIMI risk score (P = 0.012), use of amiodarone (P = 0.038), and clopidogrel (P = 0.016) compared with GI, who used more beta-blockers (P = 0.044). The other variables were the same for both groups.

Conclusion

We did not find significant differences in the therapy of elderly patients with ASWSTE, which suggests that the strategies adopted in the ICU have been satisfactorily used.