Age and its relationship to acute coronary syndromes in the Saudi Project for Assessment of Coronary Events (SPACE) registry: The SPACE age study

Objective: To characterize risk profile of acute coronary syndrome (ACS) patients in different age groups and compare management provided to in-hospital outcome. Design: Prospective multi-hospital registry. Setting: Seventeen secondary and tertiary care hospitals in Saudi Arabia. Patients: Five thousand and fifty-five patients with ACS. They were divided into four groups: ≤40 years, 41– 55 years, 56–70 years and ≥70 years. Main outcome measures: prevalence, utilization and mortality. Results: Ninety-four percent of patients 40 years compared to 68% of patients 70 years were men. Diabetes was present in 70% of patients aged 56–70 years. Smoking was present in 66% of those 40 years compared to 7% of patients 70 years. Fifty-three percent of the patients 70 years and 25% of those 40 years had history of ischemic heart disease. Sixty percent of patients 40 years presented with ST elevation myocardial infarction (STEMI) while non-ST elevation myocardial infarction was the presentation in 49% of patients 70 years. Thirty-four percent of patients 70 years compared to 10% of patients 40 years presented 12 h from symptom onset with STEMI. Fifty-four percent of patients 70 compared to 64–71% of those 70 years had coronary angiography. Twenty-four percent of patients 70 compared to 34–40% of those 70 years had percutaneous coronary intervention. Reperfusion shortfall for STEMI was 16–18% in patients 56 years compared to 11% in patients 40 years. Mortality was 7% in patients 70 years compared to 1.6–3% in patients 70 years. For all comparisons (p 0.001). Conclusions: Young and old ACS patients have unique risk factors and present differently. Older patients have higher in-hospital mortality as they are treated less aggressively. There is an urgent need for a national prevention program as well as a systematic improvement in the care for patients with ACS including a system of care for STEMI patients. For older patients there is a need to identify medical as well as social factors that influence the therapeutic management plans.