To assess the impact of mental status alteration (MSA) at presentation for acute coronary syndrome (ACS) on cardiovascular events among elderly.

After exclusion of patients with unstable conditions, neurological disorders or language deficiency, we assessed MSA defined by an abnormal confusion assessment test or Mini Mental Status Evaluation (MMSE<27) in 301 patients≥75 years old. 3-months follow-up was completed in all patients. Mortality, the primary endpoint of the study was assessed using a cox model adjusted on age, gender, and GRACE score.

MSA was identified in 161(53%) patients. MSA was associated with older age (83±5 vs 81±5, p<0.0001), female gender (53 vs 41%, p=0,04), lower education level (p=0.0001), and higher rates of Killip Class≥2 (47 vs 29%, p=0.03). The invasive management and medical therapy were similar between patients with or without MSA. Rates of 3 months mortality and re-hospitalization were higher in MSA patients (16.1 vs 3.6%, p=0.0003 and 40.3 vs 23.2%, p=0.002). The adjusted cox model identified MSA (HR 3.6 [1.4-9.6]) ormmSE (HR 0.87 per point [0.82-0.94]) as well as GRACE score (HR 1.02 per point[1.0001-1.03]) as independent predictors of 3-month mortality.

MSA is detected in a majority of patients≥75 years old presenting with ACS using simple clinical tests. Despite similar management the rates 3-month mortality and re-hospitalization are dramatically increased in such patients. MSA is an independent predictor of mortality in the elderly. Our study supports the routine assessment of MSA in such patients as a risk assessment tool. A specific management of such high-risk patients should be considered and assessed.