Abstract

GIORGI, Mariano A. et al. Differences in the Clinical Characteristics and Hospital Outcome between Primary and Secondary Unstable Angina in the Elderly. Rev. argent. cardiol. [online]. 2007, vol.75, n.2, pp.90-95. ISSN 1850-3748.

Background Unstable angina (UA) may be classified as primary (PA) or secondary (SA) based on the presence or absence of secondary causes of ischemia. Such conditions are frequent in the elderly population and could influence its prognosis. Objective The goal of this study was to assess the clinical characteristics and in-hospital outcome of elderly patients with primary and secondary UA. Material and Methods A total of 298 elderly patients were included (age ³ 75 years) with a final diagnosis of UA. The sample was divided into two groups: PA and SA, according to the presence or absence of secondary causes of ischemia (anemia, tachycardia, uncontrolled hypertension, infection, hyperthyroidism). The following parameters were compared: clinical characteristics at admission, treatment, procedures and the occurrence of death, or death and infarction during the hospital stay. Univariate predictors of poor outcome were identified. Results Fifty-two patients (17.45%) had SA and 246 (82.5%) had PA. Patients with SA were older and had higher blood pressure and heart rate values at admission. Medical treatment, coronary angiography and revascularization were less used in the group with SA. Mortality (7.7% versus 6.9% [p = 1.00; OR (95% CI ) = 1.12 (0.36-3.48)] in SA and PA, respectively) and the combination of death or infarction (7.7% versus 9.7% [p = 0.79; OR (95% CI) = 0.77 (0.25-2.32)] in SA and PA, respectively) were similar. For both groups, univariate predictors of death and infarction were ST segment depression and the development of heart failure, and for the group with PA such predictors were refractoriness and the need for coronary angiography and revascularization. Conclusion Secondary angina is a common cause of ischemia in the elderly. Although its management is different and etiology-oriented, its prognosis is similar to that of PA.

Keywords : Elderly; Unstable angina; Myocardial ischemia.

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