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.