[Risk factors for lethal outcomes in elderly and senile patients with acute coronary syndrome: An analysis of a large vascular center registry.].

Objective - to identify key risk factors for in-hospital mortality in elderly and senile patients with acute coronary syndrome (ACS) based on an analysis of a large vascular center registry. A prospective analysis of 14 321 ACS cases from 2016-2024 at the Alexandrovskaya Hospital (Saint-Petersburg) was conducted. Patients were stratified by age: <60 years, 60-74 years, 75-89 years, and ≥90 years. Demographic, clinical, laboratory, and instrumental parameters were assessed, including the Charlson Comorbidity Index. Multivariate logistic regression and ROC analysis were used for statistical evaluation. The study found that with increasing age, there was a progressive rise in the proportion of women (from 25,5 to 89,9%), comorbidity (Charlson Index - 3,1±1,2 vs. 7,9±1,5 points), myocardial injury severity (elevated troponin levels - 29,1 vs. 52,3%), and complication rates (in-hospital mortality - 2,2 vs. 29,7%, respectively). Despite comparable rates of coronary angiography (90,9-93,3%) and percutaneous interventions (74,2-76,7%) across all groups, patients aged ≥75 years had significantly higher incidences of cardiogenic shock (18,4 vs. 2,5%), pulmonary edema (11,6 vs. 1,1%), and cardiac arrest (27,2 vs. 1,6%). Multivariate analysis revealed age-dependent predictors of mortality:1) <60 years: Killip class IV (OR=40,5), reduced LVEF (OR=0,93); 2) 60-74 years: low systolic BP (OR=0,94), hypercreatininemia (OR=1,01);3) ≥75 years: STEMI (OR=23,3), renal dysfunction (OR=1,01). The prognostic models demonstrated high accuracy (AUC=0,865-0,944) and specificity (0,910-0,999). Senile patients with ACS exhibit unique risk factors, including comorbidity, renal insufficiency, and hemodynamic instability. The findings underscore the need for an individualized treatment approach that accounts for age-associated risks. The developed models may be useful for patient stratification in clinical practice.