[Management of unstable angina: advanced age is still an independent predictive factor of more conservative management after prognostic stratification with stress test].

Background and Objective: In the management of ischemic heart disease, elderly patients constitute a subgroup that, despite having a worse prognosis, are usually managed more conservatively. The objective of this study was to evaluate if, in the management of unstable angina, a more conservative attitude in elderly patients is maintained after stratification by exercise test.
Patients and Methods: The study population is constitude by 859 patients admitted to hospital due to suspected unstable angina that were referred to exercise test after medical stabilization. The management (invasive versus conservative, according to submission to cardiac catheterization or not) of patients was retrospectively studied, comparing patients < or = 70 versus > 70 years-of age.
Results: Out of the 859 patients, 156 (18%) were > 70 years old, and the exercise test was positive in 281 (33%). Cardiac catheterization was performed in 494 (57%): 62% in older and 38% in younger patients (p < 0.0001). Other characteristics associated with a more conservative management were: a negative exercise test, > 85% of the maximum heart rate, duration of exercise test more than 6 minutes, female gender, smoking and absence of episodes of rest angina. In the multivariate analysis, the statistically significant characteristics associated with an invasive management were the result of the exercise test (OR for positive result: 4.50; IC 95% = 2.73-7.63; p < 0.0001), the duration of exercise (OR for > or = 6 minutes: 0.51; IC 95% = 0.29-0.88; p = 0.0177), the percentage of the maximum heart rate (OR for > or = 85%: 0.65; IC 95% = 0.42-0.98; p = 0.0391) and age (OR for > 70 years 0.36; IC 95% = 0.20-0.62; p = 0.0004).
Conclusions: In the management of unstable angina, elderly patients constitute a more conservatively managed subgroup even after risk stratification with exercise test.