Background

There is currently a paucity of evidence on how to optimally treat elderly patients presenting with non-ST-elevation myocardial infarction (NSTEMI). The EVALUATE-Pilot-Study was designed as a nonrandomized, prospective, single-centre study to evaluate the choice of treatment and 8-months-outcome of patients > 75 years presenting with NSTEMI. Special attention was payed to the functional status, comorbidities and frailty. 

Methods

Consecutive patients ≥ 75 years presenting with NSTEMI to our hospital between 07/17 and 07/18 were included into the EVALUATE-study. Patients were asked to participate and sign informed consent 0 to 2 days after reception. Demographic data, past medical history and present medical condition were documented. During day 0 and day 2 geriatric assessment including clinical frailty scale, Barthel-Index, charlson comorbidity index (CCI), “Timed up and go”-Test (TUG), Mini Mental Status Test, Geriatric depression scale, SF-36 (Quality of life), IADL, Killip-Score, Grace-Score and Euro-Score were performed. After 8 months patients were re-evaluated either within a follow-up stay or by a visit at home. Functional decline was defined as a decrease in Barthel-Index by at least 20 points.

Results

Of 106 patients (mean age 81.9±5.3, 57% male), 68 pts. (64%) were treated with intervention, 38 pts. (36%) conservatively. Patients treated with intervention were significantly younger (80.9±4.7 vs. 83.5±6.0; p=0.02) and had a lower Killip-Score (1.16±0.37 vs. 1.37±0.63, p=0.05). All other demographic variables as well as cardiovascular risk factors, functional status and laboratory parameters were comparable. Mean Barthel-Index at baseline was 85.9 ± 20.5 and showed no significant difference between patients treated with intervention and conservatively treated patients (88.0±19.9 vs. 82.2±21.4, p=ns).

Patients were followed-up after 33±12 (34±14 vs 33±10, p=ns) weeks if alternate endpoints (death, severe cognitive impairment) had not already been reached. 22 patients (21%) were lost to follow-up. 

Mean Barthel-Index at follow-up was 84.9 ± 23.5. Functional decline was observed in 10 patients (17%). Grace Risk Score (OR 1.04, 95% CI: 1.00-1.08, NR² 0.125, p=0.04), Euro Score (OR 1.53, 95% CI: 1.12-2.23, NR² 0.189, p=0.01), CCI (OR 1.57, 95% CI: 1.15-2.32, NR² 0.223, p=0.01) and TUG (OR 1.14, 95% CI: 1.02-1.30, NR² 0.206, p=0.03) predicted functional decline. Age was no significant predictor of functional decline (OR 1.12, 95% CI: 1.00-1.26, NR²0.096, p=ns),

Conclusion

In this prospective analysis of consecutive patients > 75 years presenting with NSTEMI functional decline was observed in about every fifth patient, thus being a highly relevant problem for this patient collective. Cardiac risk scores (Grace Score, Euro Score), comorbidity burden (CCI) and gait speed (TUG) predicted functional decline.
More evidence on functional decline, its predictors and possible prevention is needed.