| [Background]Acute coronary syndrome(ACS) is an acute coronary heart disease. It is mainly caused by acute myocardial ischemia and infarction based on coronary atherosclerosis plaque rupture, platelet congestion and thrombosis. It has high incidence and high fatality rate. In the developed countries, the proportion of people of age above 60 years old accounted for 20%, and predicted to reach to 32% in 2050.Accordingly,the incidence of acute coronary syndrome in elderly people is raised correspondingly. With the rapid development of economy and the lifestyle changing, China started to become an aging society. With the risk factors of angiocardiopathy increased, such as hypertension and diabetes. ACS-related morbidity has gradually been rising in China. Acute coronary syndrome has been the major cause of death in elderly patients.ACS includes a group of diseases are different in the clinical characteristics, risk and prognosis. Elderly and very elderly patients with ACS have a high risk of death and adverse outcome because of abnormal symptoms and mutiple complications. The steps of diagnosis included analyzing the risk factors for the elderly patients, and then giving the appropriate risk stratification to them to make proper therapeutic decision and monitor prognosis. At present, lots of studies came from abroad; domestic experiments have suggested that inflammatory reaction, platelet activation, functional disorder of endothelial cell and necrosis of cardiac muscle cell commonly participate the processes of the occurrence and progression of ACS. Many mediators of inflammation and markers of myocardial damage were released into blood circulation. Detecting the concentrations of these markers is helpful for diagnosis, prognosis and medical decision making. Although many studies about serum markers have had significant improvement in recent years, there were rarely the experiments which included elderly and very elderly patients with ACS. The value of these study's conclusions in elderly patients was still uncertain. Thus, it is significant to analyze the clinical characteristics and biochemical indicators and to find out the convenient methods risk stratification and prognosis assessment for the management of ACS in the elderly and the very elderly.[Objectives](1)To investigate the basic characteristics and the concentrations of serum high sensitivity C-reactive protein(hs-CRP), white blood corpuscle(WBC) count, cardiac troponin I(cTnI), fasting blood glucose(FBG), left ventricular ejection fraction(LVEF) and other laboratory tests in elderly patients with ACS and to seek fators correlated with the different clinical types. The Objective was to find out the value of the markers in early diagnosis and risk stratification and analyse the correlations of the markers with each other.(2) According to the main adverse cardiac events (MACE) recorded within 30 days, it can be the study of prognostic factors and the risk in elderly patients with acute coronary syndrome(ACS).[Methods]This prospective study included 93 hospitalized patients over 75 years of age with an admission diagnosis of ACS.Patients were managed into three groups, unstable angina pectoris (n=63), non-ST-segment elevation myocardial infarction(n=16)and ST-segment elevation myocardial infarction(n=14). Clinical characteristics diagnostic tests, final diagnosis, destination and length of stay were recorded. All the patients had hs-CRP, WBC, cTnI, TC, TG, LDL-c, HDL-c, LP(a), FBG evaluated in the first 24 hours of admission. LVEF was evaluated in the duration of hospital stay. All the data was assessed by statistical program SPSS.[Results](1) The age among the groups of NSTEMI and STEMI is elder than group UAP, male is more than female in groups of NSTEMI and STEMI (P<0.05). Compare between the STEMI and NSTEMI groups, the ratio of patients with old myocardial infarction and hyperlipermia history male is less than female (P<0.05). The concentrations of Serum hs-CRP, WBC, cTnI in STEMI and NSTEMI groups were significant higher than in UAP group (P<0.05); In group STEMI, The concentrations of Serum cTnI was obviously raised than in group NSTEMI, but not so notable on LVEF, however the significant differences still were existed (P<0.05). According to the correlation analysis, The concentrations of Serum FBG,hs-CRP,WBC, cTnI have the positive correlation among the UAP,NSTEMI and STEMI groups (r=0.242,0.554,0.510,0.813,P<0.05). Furthermore, The correlation of LVEF among the three groups were inverse (r=-0.417, P<0.01). The levels of FBG,hs-CRP,WBC were positive correlating with cTnI (r=0.249,0.474,0.532,P<0.01) (2) Compared with the event-free group, the ACS group had low ratio of secondary prevention, and low level of LVEF (P<0.01). The result of multivariate logistic regression analysis shows that The concentrations of Serum FBG,hs-CRP and cTnI are the independent risk factors of aged patients in the 30-day MACE (OR=9.220, 94.495, 2.362, 1.443, P<0.05).[Conculsions](1) Our preliminary results suggest that age and male are the inevitable risk factors of aged ACS. Elderly people should well control the levels of blood pressure and blood glucose, and also avoid passive smoking.(2) UAP and NSTEMI usually happen to aged people, the 30-day MACE is high in the NSTEMI and STEMI. The concentrations of Serum hs-CRP,WBC,cTnI and FBG could be considered as the independent predictive factors for the 30-day MACE in very elderly patients. The concentrations of Serum hs-CRP,WBC,cTnI and FBG also had positive correlation among the groups of UAP,NSTEMI and STEMI.(3) the correlation also existed among hs-CRP,WBC,cTnI and FBG, which supported that the combination measurement in diagnosis for ACS in very elderly people was more sensitivity and specificity. To make use of the combination measurement could help the assessment of risk stratification and prognosis assessmen in ACS elderly patients.
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