Clinical impact of valvular heart disease in elderly patients admitted for acute coronary syndrome: insights from the Elderly-ACS 2 Study

ABSTRACT Background Elderlies are underrepresented in clinical trials and registries and a gap of evidence exists for clinical decision making in the setting of acute coronary syndromes (ACS). We aimed to assess the prevalence and independent prognostic impact of valvular heart disease (VHD) diagnosed during the index hospitalization on clinical outcomes among elderly patients with ACS. Included VHD were moderate-to-severe mitral regurgitation (MR), moderate-to-severe aortic stenosis (AS) or both combined. Methods We explored the Elderly-ACS 2 dataset which includes patients older >74 years diagnosed with ACS and invasively managed. The primary endpoint was a composite of all-cause death, myocardial infarction, disabling stroke and re-hospitalization for heart failure at 1 year; the secondary endpoint was death for cardiovascular causes. Patients were stratified into four groups: no VHD, moderate-to-severe MR, moderate-to-severe AS and both moderate-to-severe MR and AS. Results Of the 1,443 subjects enrolled, 190 (13.2%) had moderate-to-severe MR, 26 (1.8%) had moderate-to-severe AS and 13 (0.9%) had both moderate-to-severe MR and AS. When compared with those with no-VHD, patients with moderate-to-severe MR had an Hazard Ratio (HR) for the primary endpoint of 2.04 [95% Confidence Interval (CI) 1.36–3.07], those with moderate-to-severe AS had an HR of 3.10 [95% CI 1.39–6.93] and those with both moderate-to-severe MR and AS had an HR of 4.00 [95% CI 1.65 – 9.73] (all p Conclusions In a contemporary cohort of elderly patients admitted for ACS, VHD was found in one out of five subjects and had an independent, consistent impact on prognosis.