Background

The EVALUATE-Pilot-Study is a nonrandomized prospective, single center evaluation of treatment and outcome of patients > 75 ys. presenting with ACS with regard to preexisting comorbidity, functional status and frailty index. Since the relevance of dementia regarding treatment and outcome in this patient group is not known, we evaluated the role of dementia in physican decision making for treatment in an elderly ACS-patient cohort. 

Methods

Consecutive patients > 75 ys. presenting with Non-ST-elevation myocardial infarction (NSTEMI) to our hospital between 07/17 and 07/18 were included into the pilot study. Between day 0 and day 2 the patients were asked to participate in the study and signed informed consent. Demographic data, past medical history and present medical condition were documented. During day 0 and day 2 geriatric assessment including clinicical frailty scale, Barthel-Index, Charlson comorbidity index, “Timed up and go”-Test, Mini Mental Status Test, Geriatric depression scale, SF-36 (Quality of life), IADL, Killip-Score, Grace-Score and Euro-Score were performed. After 6 month patients were re-evaluated.

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=0.015), had a lower history of cerebral events (17.6% vs. 26.3%; p=ns) and suffered more often from COPD (17.6% vs. 34.2%; p=0.05). All other demographic variables were comparable between both groups. Of all patients 14 (14.1%) had mild dementia (MMS 19 - 23 pts.), 5 (5.1%) had moderate dementia (MMS 10-18 pts.) and 4 (4.0%) had severe dementia (MMS 0 – 10 pts.). There was no significant difference found regarding the treatment (interventional 25.81 ± 5.42 vs conservative 24.20 ± 6.35, p=ns) or the outcome. The endpoint Dementia – defined as not being able to participate Follow-Up due to dementia – is reached more often in patients being treated conservatively (17.2% vs 1.8%, p=0.01).

Conclusion

In this prospective analysis of consecutive patients > 75 years with ACS we found no significant differences in patients with high or low dementia levels regarding the prediction of the following treatment and outcome. Patients being treated conservatively reach more often the endpoint dementia. This may be partly explained by the different mean age of both groups.