Outcome of Very Elderly (Octogenarians) Patients with Coronary Artery Disease, All Diagnosed by Coronary Angiography

Background: Women with ischemic heart disease (IHD) typically present less severe coronary artery atherosclerosis. Despite that, as compared with men, women maintain a worse outcome. This female susceptibility seems to be mainly related to older age of clinical presentation and heavier risk factors burden. Purpose: To investigate whether sex differences exist in the real-world management and clinical outcome of elderly patients with suspected IHD. Methods: Retrospective analysis of IHD elderly (≥ 80 years) patients undergoing coronary angiography for acute coronary syndrome (ACS) or stable angina (SA). Management strategy, including invasive revascularization or a conservative medical approach, and outcome were evaluated. Results: A total of 1420 (41% women; mean age: 83.1 ± 2.8) IHD patients referring for ACS (43%) and SA (57%) were analyzed. Men more likely accessed for SA (59.6% vs 52.5%, p<0.001) whereas ACS was the most frequent reason for angiography in women (28.8% vs 21.5%, p<0.001). No significant sex differences in the burden of obstructive epicardial disease were observed in both ACS and SA patients. No sex disparities in antiplatelet therapy, specifically clopidogrel, were detected. Compared with SA men patients, female ones received more likely a conservative therapy (p=0.049). After a median (IQR) follow-up time of 39.0 (16-71) months, a total of 514 (36%) patients died. No sex differences in cardiac death (p=0.139) was observed. Nevertheless, the Kaplan Meier curves showed a trend in lower all-cause mortality in female group (p=0.093). Conclusions: In the very elderly population, an invasive strategy is superior to a conservative one in terms of survival rate. However, a dilution of the efficacy occurs with increasing age and comorbidities, and for male patients the benefit of the invasive strategy is not clear. Prospective studies are warranted to evaluate the net benefit of an invasive or a conservative approach in older population.