Long term survival in elderly patients with stable coronary disease

Purpose: This study aimed to assess long-term prognosis of stable coronary artery disease (sCAD) in patients aged ≥75 years and to identify clinical predictors of cardiovascular and overall mortality. Methods: From February 2000 to January 2007, 391 outpatients aged ≥75 years (median 78 years, interquartile range [IQR] 76-81 years, 66% male) with sCAD were recruited in this prospective cohort study. Associations of baseline variables with long-term cardiovascular and all cause death were investigated. Results: After up to 11 years of follow-up (median 4 years, IQR 2-6 years), 89 patients died (23%, 5.45%/year), 35 from cardiovascular causes (9%, 2.14%/year). Multivariate analysis identified family history of coronary disease (HR 4.28, 95% CI 1.22-15.02, p=0.02), baseline atrial fibrillation (HR 3.18, 95% CI 1.37-7.39, p=0.007), age (HR 1.61 per 5 year-increase, 95% CI 1.04-2.50, p=0.03), resting heart rate (HR 1.26 per 5 bpm-increase, 95% CI 1.09-1.47, p=0.003), and previous revascularization (HR 0.17, 95% CI 0.04-0.77, p=0.02) as independent predictors of cardiovascular death; and previous acute coronary syndrome (HR 4.93, 95% CI 1.49-16.30, p=0.009), baseline atrial fibrillation (HR 1.96, 95% CI 1.12-3.43, p=0.02), tobacco use (HR 1.69, 95% CI 1.00-2.84, p=0.049 for ex-smoking and HR 6.78, 95% CI 0.89-51.47, p=0.06 for active smoking), age (HR 1.58 per 5 year-increase, 95% CI 1.18-2.11, p=0.002), resting heart rate (HR 1.10 per 5 bpm-increase, 95% CI 1.00-1.22, p=0.05) and diastolic blood pressure (HR 0.97, 95% CI 0.94-0.99, p=0.01), as independent predictors of overall mortality. Conclusions: In this study, 4-years overall mortality was 23% among elderly patients with sCAD. Simple clinical variables can identify patients at higher risk of mortality.