Background: Due to an ageing population in Europe, there will be more and more elderly patients presenting with non-ST-elevation acute coronary syndromes (NSTE-ACS). Despite these findings there is limited data available on outcomes of elderly patients (>75 years) either in observational studies or randomized controlled trials. (1) Objective: To explore whether early percutaneous coronary intervention (PCI) within 24 hours of admission may improve outcomes in elderly patients (>75 years).

Patients and Methods: We analyzed elderly patients enrolled in 41 hospitals referring data to the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC)

registry (NCT01218776) from January 2010 to January 2018. The primary end-point was composed of 30-day mortality and severe LVSD, defined as ejection fraction <30% as measured by echocardiography on discharge. The components of primary end-point were analyzed as secondary end points. For the safety analysis Thrombolysis in Myocardial Infarction (TIMI) major and minor bleeding events were analyzed. A landmark analysis was performed with a cut-off point of 24h excluding all patients that died within this time. We also excluded all patients who received PCI after 24h or who had a coronary artery bypass surgery. As an added analysis we also performed an inverse probability of treatment weighting (IPTW) analysis to balance clinical covariates.

Results: There were 957 subjects with a mean age of 80±4 years in the medical therapy group and 298 subjects with a mean age of 79±4 years in the PCI group. After multivariate adjustment for age, sex, renal function, risk factors, clinical presentation, prior cardiovascular disease and in hospital medical therapy (within 24h), early PCI reduced the occurrence of the primary end-point in the cohort (OR, 0,38; 95% CI 0.22–0.68). The secondary endpoints of severe LVSD and 30-day mortality were reduced in the PCI cohort as well (OR 0,45; 95% CI 0,23-0,88) and (OR 0,33; 95% CI 0,13-0,84) respectively. The effect on the primary end-point persisted after IPTW, even though the effect was less pronounced in comparison with the unweighted model (OR 0,89; 95% CI 0,85–0,92); Figure 1). Bleeding events occurred in 4 patients (2.4%) in the PCI group and 0 in the medical therapy group (P=0.671).

Conclusion: Elderly patients treated with early PCI showed reduced rates of primary and secondary end-points compared to those treated with medical therapy. There was no significant difference in the number of bleeding rates between the groups.