Letter to the Editor Centenarians with acute coronary syndrome — Biological and not chronological age counts Paul Erne a,b , Andreas W. Schoenenberger c , Dragana Radovanovic d, ⁎ a Clinic St. Anna, Lucerne, Switzerland b Department of Cardiology, University Hospital, Zurich, Switzerland c Division of Geriatrics, Department of General Internal Medicine, University Hospital, Berne, Switzerland d AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland article info Article history: Received 10 March 2015 Accepted 19 March 2015 Available online 20 March 2015 Keywords: Acute coronary syndrome Therapy Outcome Centenarians Global population aging is a medical and economic challenge. Being old is not about the number of years, but the actual biological age, however, this is difficult to standardize in clinical practice [1]. Although centenarians are less likely to die of ischemic heart diseases [2], no stud- ies have to our knowledge specifically addressed centenarians with acute coronary syndromes (ACS). This extremely small population was always grouped together with either octogenarians or nonagenar- ians [3,4]. From all patients admitted with ACS from 2000 to 2013 and enrolled in the prospective Swiss national registry of Acute Myocardial Infarction (AMIS Plus) [5], 20 (0.05%) were aged from 100–107 years. Of these patients, 13 were females and 7 males, 6 patients presented with ST- segment elevation myocardial infarction (STEMI) and 14 with non- STEMI/unstable angina; only 6 patients had typical symptoms, 3 pa- tients had atrial fibrillation, and 5 had pulmonary edema (Killip class III), but none were in cardiogenic shock at admission. Four patients had no comorbidities, six had moderate to severe renal disease, four had cerebrovascular diseases, two were diabetic, one had heart failure and one had cancer. The most common risk factor was hypertension (67%), two patients had dyslipidemia and two were current smokers. The guidelines only marginally cover the treatment of very old ACS pa- tients and there are no evidence-based recommendations since the numbers are too low to allow prospective trials. The immediate drug therapies (within 24 h) provided to these 20 patients were as follows: 7 received low molecular weight heparins, 6 unfractionated heparin, 5 P2Y12 antagonists, 3 statins, 16 aspirin, 9 angiotensin-converting- enzyme inhibitors and 5 beta-blockers. Only one patient was palliatively treated (receiving aspirin and analgesics only). Three of the centenar- ians (16% versus 74% of other ACS patients) underwent timely percuta- neous coronary interventions with a door-to-balloon time of 39 min (IQR 26, 72 min) versus 100 min (IQR 34, 425 min) for other ACS pa- tients; one centenarian had drug-eluting stent implantation and one had thrombus aspiration. There were various in-hospital complications: one patient developed cardiogenic shock, one acute renal failure, one paroxysmal atrial fibrillation and one had recurrent ischemic episodes. No one suffered from bleeding, re-infarction or stroke. The length of stay (median 5 days; IQR 2, 11 days) was comparable to other ACS patients (5 days; IQR 2, 9 days). Five patients died in hospital due to pump failure (25% versus 6% of other ACS patients) but the invasively treated centenarians were all alive at discharge. Eight patients were discharged to retirement or nursing homes. This report on a small cohort of centenarians who presented with ACS might indicate that the chronological age might not correspond to the biological age. Conflict of interest The authors report no relationships that could be construed as a con- flict of interest. References [1] M. Romanens, F. Ackermann, I. Sudano, T. Szucs, J.D. Spence, Arterial age as a substi- tute for chronological age in the AGLA risk function could improve coronary risk pre- diction, Swiss Med. Wkly. 144 (2014) w13967. [2] C.J. Evans, Y. Ho, B.A. Daveson, et al., Place and cause of death in centenarians: a population-based observational study in England, 2001 to 2010, PLoS Med. 11 (2014) e1001653. [3] J. Tjia, J. Allison, J.S. Saczynski, et al., Encouraging trends in acute myocardial infarction survival in the oldest old, Am. J. Med. 126 (2013) 798–804. [4] O.A. Alabas, V. Allan, J.M. McLenachan, R. Feltbower, C.P. Gale, Age-dependent im- provements in survival after hospitalisation with acute myocardial infarction: an analysis of the Myocardial Ischemia National Audit Project (MINAP), Age Ageing 43 (2014) 779–785. [5] D. Radovanovic, P. Erne, AMIS Plus: Swiss registry of acute coronary syndrome, Heart 96 (2010) 917–921. International Journal of Cardiology 187 (2015) 154 ⁎ Corresponding author at: AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich. E-mail address: dragana.radovanovic@uzh.ch (D. Radovanovic). http://dx.doi.org/10.1016/j.ijcard.2015.03.298 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved. Contents lists available at ScienceDirect International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard