Patient-dependent variables affecting treatment and prediction of acute coronary syndrome are age-related. A study performed in Israel

Background: Acute coronary syndrome (ACS) prevails in older patients and is associated with higher morbidity and mortality. Little is known about patient-related variables that may affect course and treatment of ACS in older vs. younger with acute chest pain. Methods: Situational, circumstantial, and other patient-related variables were assessed in 1000 unselected consecutive older (≥ 70 years) and younger (< 70 years) patients admitted with chest pain and possible ACS. Results: In 182 older vs. 818 younger patients, prevalence of females, those not speaking the local language, living alone, lower education level, non-smokers, diabetes, hypertension, preexisting coronary artery disease, and attempting some form of self-treatment before seeking medical help were significantly greater (P < 0.001). Interval from chest pain onset to emergency department arrival was longer (P = 0.05), and a higher proportion of the older considered hospitalization mandatory, suspecting ACS (P < 0.001). ACS eventually developed in 19.1% of younger and 39% of older patients (P < 0.001). On multivariate analysis, most predictive of ACS in the younger group were: preexisting coronary artery disease (OR 5.27; 95% CI 3.44-8.07, P < 0.001), current smoking (OR 1.78; 95% CI 1.16-2.75, P = 0.002), male sex (OR 1.57; 95% CI 1.0-2.59, P = 0.07), and older age (OR 1.25; 95% CI 1.11-1.42, P = 0.005). In the older group, these were: not speaking the local language (OR 2.39; 95% CI 1.19-4.79, P = 0.005), preexisting coronary artery disease (OR 1.95; 95% CI 1.0-3.87, P = 0.026), direct emergency department arrival (OR 1.9; 95% CI 1.0-3.77, P = 0.066), and diabetes (OR 1.84; 95% CI 1.0-3.56, P = 0.079). Conclusions: We defined age-associated differences in patient-related variables that may predict ACS and affect treatment negatively. These variables might improve risk stratification upon hospitalization.