Background: Vietnam is considered one of the countries with the fastest aging population rate in the world. As of 2019, the proportion of the population aged ≥ 60 years in Vietnam reached approximately 11.9% and continues to rise rapidly, with projections expected to exceed 25% by 2050. The significant increase in this population group leads to a substantial rise in healthcare demand and disease burden, especially in the management of non-communicable chronic diseases such as cardiovascular disorders. Non-ST segment elevation acute coronary syndrome (NSTE-ACS) is regarded as one of the leading cardiovascular causes of mortality in the elderly. Advanced age is also considered an independent risk factor that increases mortality and early adverse events following NSTE-ACS. Studies have shown that the mortality rate in patients over 75 years old with non-ST elevation myocardial infarction is approximately twice as high as that in patients under 75 years, and complications related to myocardial infarction – such as heart failure, renal impairment, bleeding, and stroke – also increase significantly with age.
Objectives: To investigate the clinical characteristics, paraclinical features, and treatment of non-ST segment elevation acute coronary syndrome in elderly patients at Nhan dan Gia Dinh Hospital
Methods: This study is a two-phase retrospective study conducted from April 2022 to February 2023 and from January 2025 to December 2025, involving 279 elderly patients aged ≥ 60 years diagnosed with non-ST segment elevation acute coronary syndrome at Nhan dan Gia Dinh Hospital
Results: A total of 279 elderly patients (≥ 60 years old)with non-ST segment elevation acute coronary syndrome were included, with a mean age of 70.87 ± 7.95 years. Among them, the young-old group (60-69 years) accounted for the highest proportion at 53.05%, the middle-old group (70-79 years) accounted for 29.39%, and the oldest-old group (≥ 80 years) accounted for the smallest proportion at 17.56%. Females were predominant, with 156 cases (55.91%). The average hospital length of stay was 6.40 ± 6.28 comorbidity was hypertension (83.51%), followed by dyslipidemia (41.94%) and diabetes mellitus (40.86%). Reduced left ventricular ejection fraction (EF ≤ 40%) was observed in 21.51% of patients. Nineteen percent of patients had a GRACE score ≥ 140, and 19.35% were classified as high bleeding risk according to the ARC-HBR criteria. Percutaneous coronary intervention (PCI) was performed in 155 patients (55.56%). The incidence of in-hospital complications was very low, including bleeding (1.79%), contrast-induced acute kidney injury (2.15%), vascular access complications during PCI (3.23%), and notably, the in-hospital mortality rate was only 3.58%. Univariate analysis showed that factors at the time of diagnosis – including high bleeding risk based on the ARC-HBR score, white blood cell count, neutrophil percentage, platelet count, liver transaminase levels (SGOT, SGPT), first high-sensitivity troponin I level, GRACE score ≥ 140 – as well as treatment-related factors such as contrast-induced acute kidney injury, bleeding events, and concomitant acute infections showed statistically significant differences (p < 0.05) between patients with and without in-hospital mortality.
Conclusion: Events such as hemorrhage, contrast-induced acute kidney injury, vascular access injury during PCI, and particularly in-hospital mortality occur at very low rates. Factors including white blood cell count, platelet count, liver enzyme levels, high-sensitivity cardiac troponin values, presence of hemorrhage, contrast-induced acute kidney injury, the GRACE score, and bleeding risk assessment according to the ARC-HBR consensus play a role in predicting the risk of in-hospital mortality in elderly patients.