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Chowdhury MRK, Stub D, Dinh D, Karim MN, Siddiquea BN, Billah B. Preoperative Variables of 30-Day Mortality in Adults Undergoing Percutaneous Coronary Intervention: A Systematic Review. Heart Lung Circ 2024; 33:951-961. [PMID: 38570260 DOI: 10.1016/j.hlc.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND AND AIM Risk adjustment following percutaneous coronary intervention (PCI) is vital for clinical quality registries, performance monitoring, and clinical decision-making. There remains significant variation in the accuracy and nature of risk adjustment models utilised in international PCI registries/databases. Therefore, the current systematic review aims to summarise preoperative variables associated with 30-day mortality among patients undergoing PCI, and the other methodologies used in risk adjustments. METHOD The MEDLINE, EMBASE, CINAHL, and Web of Science databases until October 2022 without any language restriction were systematically searched to identify preoperative independent variables related to 30-day mortality following PCI. Information was systematically summarised in a descriptive manner following the Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies checklist. The quality and risk of bias of all included articles were assessed using the Prediction Model Risk Of Bias Assessment Tool. Two independent investigators took part in screening and quality assessment. RESULTS The search yielded 2,941 studies, of which 42 articles were included in the final assessment. Logistic regression, Cox-proportional hazard model, and machine learning were utilised by 27 (64.3%), 14 (33.3%), and one (2.4%) article, respectively. A total of 74 independent preoperative variables were identified that were significantly associated with 30-day mortality following PCI. Variables that repeatedly used in various models were, but not limited to, age (n=36, 85.7%), renal disease (n=29, 69.0%), diabetes mellitus (n=17, 40.5%), cardiogenic shock (n=14, 33.3%), gender (n=14, 33.3%), ejection fraction (n=13, 30.9%), acute coronary syndrome (n=12, 28.6%), and heart failure (n=10, 23.8%). Nine (9; 21.4%) studies used missing values imputation, and 15 (35.7%) articles reported the model's performance (discrimination) with values ranging from 0.501 (95% confidence interval [CI] 0.472-0.530) to 0.928 (95% CI 0.900-0.956), and four studies (9.5%) validated the model on external/out-of-sample data. CONCLUSIONS Risk adjustment models need further improvement in their quality through the inclusion of a parsimonious set of clinically relevant variables, appropriately handling missing values and model validation, and utilising machine learning methods.
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Affiliation(s)
- Mohammad Rocky Khan Chowdhury
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Dion Stub
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia
| | - Diem Dinh
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Md Nazmul Karim
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Bodrun Naher Siddiquea
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
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Rozenfeld KL, Lupu L, Merdler I, Morgan S, Banai S, Shacham Y. Invasive versus Conservative Treatment Approach among Older Adult Patients Admitted with Acute ST-Segment Elevation Myocardial Infarction. Ann Geriatr Med Res 2022; 26:347-353. [PMID: 36437630 PMCID: PMC9830063 DOI: 10.4235/agmr.22.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Primary percutaneous coronary intervention (PCI) is the preferred treatment strategy for patients with ST-elevation myocardial infarction (STEMI); however, its efficacy remains unclear in very older adult patients with STEMI. METHODS This retrospective single-center observational study included 530 patients aged >75 years admitted to Tel Aviv Sourasky Medical Center with a diagnosis of acute STEMI. Primary PCI was performed for patients with symptoms ≤12 hours in duration, while the other patients were conservatively treated. We evaluated 30-day mortality and complications occurring during hospitalization based on data from patient records. RESULTS Among the study patients, only 28/530 (5%) were conservatively treated. In-hospital complications, including the use of inotropes or intra-aortic balloon counterpulsation and the need for mechanical ventilation, did not differ significantly between the groups. The only parameter that showed a trend toward significance was the incidence of heart failure during hospitalization (p=0.042). The risk for 30-day mortality was substantially higher in the conservative treatment group than in the invasive treatment group (27% vs. 10%; p = 0.02). CONCLUSION Our data suggested that despite concerns regarding the safety of the primary PCI strategy in the older adult STEMI population, this treatment strategy was associated with a survival benefit.
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Affiliation(s)
- Keren-Lee Rozenfeld
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Corresponding Author: Keren-Lee Rozenfeld, MD Department of Cardiology, Tel Aviv Sourasky Medical Center, 6 Weizman St, Tel Aviv 64239, Israel. E-mail:
| | - Lior Lupu
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Merdler
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Samuel Morgan
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yacov Shacham
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Rumiz E, Berenguer A, Vilar JV, Valero E, Facila L, Cubillos A, Sanmiguel D, Almela P, Morell S. Long-term outcomes and predictors of morbi-mortality according to age in stemi patients with multivessel disease: Impact of an incomplete revascularization. Catheter Cardiovasc Interv 2018; 92:E512-E517. [PMID: 30019820 DOI: 10.1002/ccd.27691] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 04/09/2018] [Accepted: 05/20/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Optimal management strategy for patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) still remains unclear, especially in the elderly population. The aim of this study was to assess long-term outcomes and predictors of morbi-mortality according to age in patients with a STEMI and MVD. METHODS We prospectively included 381 consecutive patients with a STEMI who underwent primary angioplasty and showed MVD in the angiogram. 111 (29.1%) patients were older than 75 (≥75) years and 270 (70.9%) were younger than 75 (<75) years. The co-primary outcomes were the incidence of all-cause mortality and major adverse cardiac events (MACE) during follow-up. RESULTS During a median follow-up of 22 months, patients ≥75 years showed a higher incidence of all-cause mortality and MACE, as compared to younger patients. On multivariate analysis, incomplete revascularization (IR) was only an independent predictor of MACE (HR = 3.1, CI 95%:1.9-4.7; P = .02) in younger patients; whereas in the elderly group severely depressed ejection fraction was the unique independent predictor of MACE (HR = 2.7, CI 95%:1.5-4.8; P = .001). IR was not associated with the risk of all-cause mortality in any group. CONCLUSION This study confirms the relevant prevalence of MVD in STEMI patients, as well as the difference in outcomes of an IR strategy between both age-groups, being only independently associated with MACE in younger patients. This finding supports that a routine complete revascularization (CR) strategy seems to be the best therapeutic option in younguer patients, whereas in the elderly population may not confer a clear clinical benefit during a long-term follow-up.
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Affiliation(s)
- Eva Rumiz
- Cardiology Department, Consorcio Hospital General Universitario de Valencia
| | - Alberto Berenguer
- Cardiology Department, Consorcio Hospital General Universitario de Valencia
| | - Juan Vicente Vilar
- Cardiology Department, Consorcio Hospital General Universitario de Valencia
| | - Ernesto Valero
- Cardiology Department, Hospital Clínico Universitario de Valencia
| | - Lorenzo Facila
- Cardiology Department, Consorcio Hospital General Universitario de Valencia
| | - Andres Cubillos
- Cardiology Department, Consorcio Hospital General Universitario de Valencia
| | - Dario Sanmiguel
- Cardiology Department, Consorcio Hospital General Universitario de Valencia
| | - Pablo Almela
- Cardiology Department, Consorcio Hospital General Universitario de Valencia
| | - Salvador Morell
- Cardiology Department, Consorcio Hospital General Universitario de Valencia
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4
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Sappa R, Grillo MT, Cinquetti M, Prati G, Spedicato L, Nucifora G, Perkan A, Zanuttini D, Sinagra G, Proclemer A. Short and long-term outcome in very old patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention. Int J Cardiol 2017; 249:112-118. [PMID: 28935461 DOI: 10.1016/j.ijcard.2017.09.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 07/04/2017] [Accepted: 09/08/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although octogenarians constitute a fast-growing portion of cardiovascular patients, few data are available on the outcome of patients aged ≥85 years with ST-Elevation Myocardial Infarction (STEMI). METHODS AND RESULTS We analyzed 126 consecutive patients aged ≥85 years (age 88±2 years) with STEMI, undergoing primary percutaneous coronary intervention (pPCI) within 12 hours from symptoms onset. Long-term follow-up (median 898 days) was obtained for the 102 patients surviving the index-hospitalization. In-hospital mortality rate was 19%. Nonagenarians, diabetes mellitus, severe left ventricular systolic dysfunction and intra-aortic balloon pumping were significantly and independently correlated to in-hospital mortality at the multivariate analysis. A low rate of complications was detected. Among patients surviving the index hospitalization, 32 (31%) patients died during follow-up. 55 patients (54%) had re-hospitalization due to cardiovascular causes. The univariate analysis identified chronic renal failure, Killip class ≥ 3, TIMI Risk Score >8 and very high risk of bleeding as predictors of long-term overall mortality. At the multivariate analysis only chronic renal failure and very high risk of bleeding were significantly and independently correlated to long-term all-cause mortality. Renal function and anterior myocardial infarction were significantly and independently associated with the combined end-point of cardiac mortality and re-hospitalization due to cardiovascular disease at the multivariate analysis. CONCLUSIONS PPCI in patients ≥85 years old is relatively safe. In this population, pPCI is associated with a good long-term survival, although still worse than in younger patients, despite a considerable incidence of re-hospitalization due to cardiovascular events.
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Affiliation(s)
- Roberta Sappa
- Cardiothoracic Department, "Azienda Sanitaria Universitaria Integrata" of Udine, Italy.
| | - Maria Teresa Grillo
- Cardiothoracic Department, "Azienda Sanitaria Universitaria Integrata" of Udine, Italy
| | - Martino Cinquetti
- Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy
| | - Giulio Prati
- Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy
| | - Leonardo Spedicato
- Cardiothoracic Department, "Azienda Sanitaria Universitaria Integrata" of Udine, Italy
| | - Gaetano Nucifora
- Cardiothoracic Department, "Azienda Sanitaria Universitaria Integrata" of Udine, Italy
| | - Andrea Perkan
- Cardiovascular Department, "Azienda Sanitaria Universitaria Integrata" of Trieste, Italy
| | - Davide Zanuttini
- Cardiothoracic Department, "Azienda Sanitaria Universitaria Integrata" of Udine, Italy
| | - Gianfranco Sinagra
- Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy; Cardiovascular Department, "Azienda Sanitaria Universitaria Integrata" of Trieste, Italy
| | - Alessandro Proclemer
- Cardiothoracic Department, "Azienda Sanitaria Universitaria Integrata" of Udine, Italy
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Ariza-Solé A, Alegre O, Elola FJ, Fernández C, Formiga F, Martínez-Sellés M, Bernal JL, Segura JV, Iñíguez A, Bertomeu V, Salazar-Mendiguchía J, Sánchez Salado JC, Lorente V, Cequier A. Management of myocardial infarction in the elderly. Insights from Spanish Minimum Basic Data Set. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 8:242-251. [DOI: 10.1177/2048872617719651] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: We aimed to assess the impact of implementation of reperfusion networks, the type of hospital and specialty of the treating physician on the management and outcomes of ST segment elevation myocardial infarction in patients aged ⩾75 years. Methods: We analysed data from the Minimum Basic Data Set of the Spanish public health system, assessing hospital discharges between 2004 and 2013. Discharges were distributed in three groups depending on the clinical management: percutaneous coronary intervention, thrombolysis or no reperfusion. Primary outcome measure was all cause in-hospital mortality. For risk adjustment, patient comorbidities were identified for each index hospitalization. Results: We identified 299,929 discharges, of whom 107,890 (36%) were in-patients aged ⩾75 years. Older patients had higher prevalence of comorbidities, were less often treated in high complexity hospitals and were less frequently managed by cardiologists ( p<0.001). Both percutaneous coronary intervention and fibrinolysis were less often performed in elderly patients ( p<0.001). A progressive increase in the rate of percutaneous coronary intervention was observed in the elderly across the study period (from 17% in 2004 to 45% in 2013, p<0.001), with a progressive reduction of crude mortality (from 23% in 2004 to 19% in 2013, p<0.001). Adjusted analysis showed an association between being treated in high complexity hospitals, being treated by cardiologists and lower in-hospital mortality ( p <0.001). Conclusions: Elderly patients with ST segment elevation myocardial infarction are less often managed in high complexity hospitals and less often treated by cardiologists. Both factors are associated with higher in-hospital mortality.
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Affiliation(s)
- Albert Ariza-Solé
- Hospital Universitario de Bellvitge, Universidad de Barcelona, Spain
| | - Oriol Alegre
- Hospital Universitario de Bellvitge, Universidad de Barcelona, Spain
| | - Francisco J Elola
- Sociedad Española de Cardiología, Guadalupe, Madrid, Spain
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - Cristina Fernández
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
- Hospital Clínico Universitario San Carlos. Universidad Complutense de Madrid, Spain
| | - Francesc Formiga
- Hospital Universitario de Bellvitge, Universidad de Barcelona, Spain
| | - Manuel Martínez-Sellés
- Hospital General Universitario Gregorio Marañón, Universidad Complutense, Universidad Europea, Madrid, Spain
| | - José L Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
- Control Management Service, 12 de Octubre Hospital, Madrid, Spain
| | - José V Segura
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
- IUI Operative Research Centre, Miguel Hernández University, Alicante, Spain
| | - Andrés Iñíguez
- Sociedad Española de Cardiología, Guadalupe, Madrid, Spain
- Hospital Alvaro Cunqueiro, Vigo, Spain
| | - Vicente Bertomeu
- Sociedad Española de Cardiología, Guadalupe, Madrid, Spain
- Hospital Universitario de San Juan, Alicante, Spain
| | | | | | - Victòria Lorente
- Hospital Universitario de Bellvitge, Universidad de Barcelona, Spain
| | - Angel Cequier
- Hospital Universitario de Bellvitge, Universidad de Barcelona, Spain
- Sociedad Española de Cardiología, Guadalupe, Madrid, Spain
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6
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Cenko E, Ricci B, Kedev S, Kalpak O, Câlmâc L, Vasiljevic Z, Knežević B, Dilic M, Miličić D, Manfrini O, Koller A, Dorobantu M, Badimon L, Bugiardini R. The no-reflow phenomenon in the young and in the elderly. Int J Cardiol 2016; 222:1122-1128. [DOI: 10.1016/j.ijcard.2016.07.209] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
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7
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Bromage DI, Jones DA, Rathod KS, Grout C, Iqbal MB, Lim P, Jain A, Kalra SS, Crake T, Astroulakis Z, Ozkor M, Rakhit RD, Knight CJ, Dalby MC, Malik IS, Mathur A, Redwood S, MacCarthy PA, Wragg A. Outcome of 1051 Octogenarian Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Observational Cohort From the London Heart Attack Group. J Am Heart Assoc 2016; 5:e003027. [PMID: 27353606 PMCID: PMC4937253 DOI: 10.1161/jaha.115.003027] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/25/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND ST-segment elevation myocardial infarction is increasingly common in octogenarians, and optimal management in this cohort is uncertain. This study aimed to describe the outcomes of octogenarians with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention. METHODS AND RESULTS We analyzed 10 249 consecutive patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention between 2005 and 2011 at 8 tertiary cardiac centers across London, United Kingdom. The primary end point was all-cause mortality at a median follow-up of 3 years. In total, 1051 patients (10.3%) were octogenarians, with an average age of 84.2 years, and the proportion increased over the study period (P=0.04). In-hospital mortality (7.7% vs 2.4%, P<0.0001) and long-term mortality (51.6% vs 12.8%, P<0.0001) were increased in octogenarians compared with patients aged <80 years, and age was an independent predictor of mortality in a fully adjusted model (hazard ratio 1.07, 95% CI 1.07-1.09, P<0.0001). Time-stratified analysis revealed an increasingly elderly and more complex cohort over time. Nonetheless, long-term mortality rates among octogenarians remained static over time, and this may be attributable to improved percutaneous coronary intervention techniques, including significantly higher rates of radial access and lower bleeding complications. Variables associated with bleeding complications were similar between octogenarian and younger cohorts. CONCLUSIONS In this large registry, octogenarians undergoing primary percutaneous coronary intervention had a higher rate of complications and mortality compared with a younger population. Over time, octogenarians undergoing primary percutaneous coronary intervention increased in number, age, and complexity. Nevertheless, in-hospital outcomes were reasonable, and long-term mortality rates were static.
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Affiliation(s)
- Daniel I Bromage
- The Hatter Cardiovascular Institute, University College London, London, UK
| | - Daniel A Jones
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | | | - Claire Grout
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - M Bilal Iqbal
- Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK
| | - Pitt Lim
- St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, UK
| | - Ajay Jain
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Sundeep S Kalra
- Kings College Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Tom Crake
- UCL Hospitals NHS Foundation Trust, Heart Hospital, London, UK
| | - Zoe Astroulakis
- St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, UK
| | - Mick Ozkor
- UCL Hospitals NHS Foundation Trust, Heart Hospital, London, UK
| | | | | | - Miles C Dalby
- Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK
| | - Iqbal S Malik
- Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, UK
| | - Anthony Mathur
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Simon Redwood
- BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, UK
| | - Philip A MacCarthy
- Kings College Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Andrew Wragg
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
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Ipek G, Kurmus O, Koseoglu C, Onuk T, Gungor B, Kirbas O, Karatas MB, Keskin M, Betul Borklu E, Hayiroglu MI, Tanik O, Oz A, Bolca O. Predictors of in-hospital mortality in octogenarian patients who underwent primary percutaneous coronary intervention after ST segment elevated myocardial infarction. Geriatr Gerontol Int 2016; 17:584-590. [DOI: 10.1111/ggi.12759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 01/08/2016] [Accepted: 01/29/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Gokturk Ipek
- Siyami Ersek Cardiothoracic Surgery Center; Department of Cardiology; Istanbul Turkey
| | - Ozge Kurmus
- Ataturk Training and Research Hospital; Department of Cardiology; Ankara Turkey
| | - Cemal Koseoglu
- Ataturk Training and Research Hospital; Department of Cardiology; Ankara Turkey
| | - Tolga Onuk
- Siyami Ersek Cardiothoracic Surgery Center; Department of Cardiology; Istanbul Turkey
| | - Baris Gungor
- Siyami Ersek Cardiothoracic Surgery Center; Department of Cardiology; Istanbul Turkey
| | - Ozgur Kirbas
- Ataturk Training and Research Hospital; Department of Cardiology; Ankara Turkey
| | - Mehmet B Karatas
- Siyami Ersek Cardiothoracic Surgery Center; Department of Cardiology; Istanbul Turkey
| | - Muhammed Keskin
- Siyami Ersek Cardiothoracic Surgery Center; Department of Cardiology; Istanbul Turkey
| | - Edibe Betul Borklu
- Siyami Ersek Cardiothoracic Surgery Center; Department of Cardiology; Istanbul Turkey
| | - Mert Ilker Hayiroglu
- Siyami Ersek Cardiothoracic Surgery Center; Department of Cardiology; Istanbul Turkey
| | - Ozan Tanik
- Siyami Ersek Cardiothoracic Surgery Center; Department of Cardiology; Istanbul Turkey
| | - Ahmet Oz
- Siyami Ersek Cardiothoracic Surgery Center; Department of Cardiology; Istanbul Turkey
| | - Osman Bolca
- Siyami Ersek Cardiothoracic Surgery Center; Department of Cardiology; Istanbul Turkey
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Outcomes of percutaneous coronary intervention in patients ≥ 75 years: one-center study in a Chinese patient group. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 12:626-33. [PMID: 26788039 PMCID: PMC4712368 DOI: 10.11909/j.issn.1671-5411.2015.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective To investigate the clinical and perioperative characteristics of patients ≥ 75 who undergoing percutaneous coronary intervention (PCI) and to evaluate the risk factors related to short-term post-PCI mortality in this specific patients group. Methods 1,035 consecutive subjects who underwent PCI from December 2011 to November 2013 were divided into four categories: (1) patients with stable angina (SA) ≥ 75 years (n = 58); (2) patients with SA < 75 years (n = 218); (3) patients with acute coronary syndrome (ACS) ≥ 75 years (n = 155); (4) patients with ACS < 75 years (n = 604). A multivariable logistic regression analysis was conducted to detect risk factors of six-month mortality in patients ≥ 75 years who had undergone PCI. Clinical comorbidities, in-hospital biochemical indicators, perioperative data, in-hospital and six-month outcomes were analyzed and compared among the four groups. Results Compared with the younger group, patients ≥ 75 years were more likely to have hypertension, history of stroke, chronic obstructive pulmonary disease, peripheral vascular disease, cardiogenic shock and malignant arrhythmia, and they were admitted to hospital with relative lower weight, hemoglobin, albumin, triglyceride, higher creatinine, uric acid, urea nitrogen and pro-BNP. Left main artery lesions, multi-vessel, calcified lesions, chronic totally occlusion were also more likely to be seen in the elderly group. Univariate analysis revealed that age ≥ 85 years, cardiogenic shock or severe arrhythmia at admission, emergency PCI, prior stroke and chronic kidney disease were related to six-month mortality in elderly patients ≥ 75 years who underwent PCI. Multivariable logistic regression showed that cardiogenic shock or severe arrhythmia at admission, chronic kidney disease and prior stroke were independent risk factors predicting six-month mortality in elderly patients ≥ 75 years who had undergone PCI. Conclusions Our data showed that, compared with patients under 75 years, elderly patients (≥ 75 years) who had undergone PCI had a relative higher risk of mortality, and more often accompanied with multi-comorbidities, severer admission conditions and complex coronary lesions. Better evaluation of risk factors and more intensively care should be taken to patients ≥ 75 years who had undergone PCI therapy to reduce complications.
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10
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Mizuguchi Y, Hashimoto S, Yamada T, Taniguchi N, Nakajima S, Hata T, Takahashi A. Percutaneous coronary intervention for nonagenarian patients with ST-segment elevation myocardial infarction: Experience of a single Japanese center. J Cardiol 2016; 67:331-4. [PMID: 26775888 DOI: 10.1016/j.jjcc.2015.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/11/2015] [Accepted: 12/01/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Old age is a prognostic risk factor for patients with ST elevation acute myocardial infarction (STEMI); however, few data exist describing STEMI patients aged over 90 years. METHODS We retrospectively evaluated the clinical indices and outcomes of 282 consecutive STEMI patients who underwent primary percutaneous coronary intervention (PCI) in our hospital between January 2008 and December 2012. Patients with acute myocardial infarction complicated by out-of-hospital cardiopulmonary arrest, patients with a left main trunk culprit lesion, and patients diagnosed more than 24h after symptom onset were excluded. RESULTS Of the patients treated during the study period, 11 (3.8%) were >90 years old. The mean door-to-balloon time was significantly longer for nonagenarians than younger patients (66.2 vs. 44.0minutes; p<0.001). This was mainly attributed to delays in decision-making regarding invasive treatment by both the doctors and families. Nonagenarians had multiple coronary artery stenoses more frequently (36.4% vs. 15.0%; p<0.05) and required intra-aortic balloon pumping more often (36.4% vs. 18.9%; p=0.15) compared with patients aged ≤89 years. However, the peak creatinine kinase levels and the left ventricular ejection fractions were similar between the groups. Moreover, the in-hospital and 30-day mortality rates were similar (9.1% vs. 4.6%, p=0.50; 9.1% vs. 3.6%, p=0.34, respectively) between the groups. The two-year survival rate was 81.8% in nonagenarians. CONCLUSIONS Despite the longer door-to-balloon time, higher use of intra-aortic balloon pumping, and larger number of diseased vessels, the 30-day and 2-year survival rates of nonagenarians with STEMI were comparable to those of younger patients.
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Affiliation(s)
- Yukio Mizuguchi
- Cardiovascular Section, Sakurakai Takahashi Hospital, Hyogo, Japan.
| | - Sho Hashimoto
- Cardiovascular Section, Sakurakai Takahashi Hospital, Hyogo, Japan
| | - Takeshi Yamada
- Cardiovascular Section, Sakurakai Takahashi Hospital, Hyogo, Japan
| | | | | | - Tetsuya Hata
- Cardiovascular Section, Sakurakai Takahashi Hospital, Hyogo, Japan
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11
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Kvakkestad KM, Abdelnoor M, Claussen PA, Eritsland J, Fossum E, Halvorsen S. Long-term survival in octogenarians and older patients with ST-elevation myocardial infarction in the era of primary angioplasty: A prospective cohort study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 5:243-52. [DOI: 10.1177/2048872615574706] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 02/04/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Kristin M Kvakkestad
- Department of Cardiology, Oslo University Hospital Ulleval, Norway
- University of Oslo, Norway
| | - Michael Abdelnoor
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Norway
| | - Peter A Claussen
- Department of Cardiology, Oslo University Hospital Ulleval, Norway
- University of Oslo, Norway
| | - Jan Eritsland
- Department of Cardiology, Oslo University Hospital Ulleval, Norway
| | - Eigil Fossum
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Norway
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, Norway
- University of Oslo, Norway
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12
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Fan GQ, Fu KL, Jin CW, Wang XZ, Han L, Wang H, Zhong M, Zhang Y, Zhang W, Wang ZH. A medical costs study of older patients with acute myocardial infarction and metabolic syndrome in hospital. Clin Interv Aging 2015; 10:329-37. [PMID: 25670890 PMCID: PMC4315548 DOI: 10.2147/cia.s70372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background Older patients with acute myocardial infarction (AMI) usually have a poor prognosis, but whether this poor prognosis leads to high hospital costs remains unclear. This study investigated the clinical outcomes of and costs incurred by older patients with AMI and metabolic syndrome (MS) in hospital. Methods and results Patients with AMI seen at Qilu Hospital of Shandong University between January 2011 and May 2013 were separated into four groups: young non-MS patients (n=282), older non-MS patients (n=324), young MS patients (n=217), and older MS patients (n=174). We found that advanced age was significantly associated with worse clinical outcomes, and that the clinical outcomes in patients with AMI and MS are also worsened. At the same cost (RMB¥10,000), older patients with and without MS had a markedly increased number of cardiovascular incidences compared with younger patients without MS. In a comparison of the incremental cost-effectiveness ratio (ICER) of percutaneous coronary intervention, older patients without MS had a lower ICER for cardiovascular incidences and a higher ICER for cardiac event-free survival rate when compared with young patients without MS, but a lower ICER for cardiovascular incidences and a higher ICER for cardiac event-free survival rate when compared with older MS patients. Conclusion Older AMI patients have poor clinical outcomes and their treatment is not cost-effective; however, the results are worse in patients with AMI and MS. Percutaneous coronary intervention is a cost-effective therapy in older patients with AMI, but its cost-effectiveness decreases in patients with AMI and MS.
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Affiliation(s)
- Guan-qi Fan
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Ji'nan, People's Republic of China
| | - Kai-li Fu
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Ji'nan, People's Republic of China
| | - Cheng-wei Jin
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Ji'nan, People's Republic of China
| | - Xiao-zhen Wang
- Shandong University of Traditional Chinese Medicine, Ji'nan, People's Republic of China
| | - Lu Han
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Ji'nan, People's Republic of China
| | - Hui Wang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Ji'nan, People's Republic of China
| | - Ming Zhong
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Ji'nan, People's Republic of China
| | - Yun Zhang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Ji'nan, People's Republic of China
| | - Wei Zhang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Ji'nan, People's Republic of China
| | - Zhi-hao Wang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Ji'nan, People's Republic of China ; Department of Geriatric Medicine, Qilu Hospital of Shandong University, Ji'nan, People's Republic of China
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13
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Schoos MM, Sejersten M, Baber U, Treschow PM, Madsen M, Hvelplund A, Kelbæk H, Mehran R, Clemmensen P. Outcomes of patients calling emergency medical services for suspected acute cardiovascular disease. Am J Cardiol 2015; 115:13-20. [PMID: 25456866 DOI: 10.1016/j.amjcard.2014.09.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 09/23/2014] [Accepted: 09/23/2014] [Indexed: 11/18/2022]
Abstract
Adequate health care is increasingly dependent on prehospital systems and cardiovascular (CV) disease remains the most common cause for hospital admission. However the prevalence of CV dispatches of emergency medical services (EMS) is not well reported and survival data described in clinical trials and registries are subject to selection biases. We aimed to describe the prevalence and prognosis of acute CV disease and the effect of invasive treatment, in an unselected and consecutive prehospital cohort of 3,410 patients calling the national emergency telephone number from 2005 to 2008 with follow-up in 2013. Individual-level data from national registries were linked to the dedicated EMS database of primary ambulance dispatches supported by physician-manned emergency units. Outcome data were obtained from the Central Population Registry, the National Patient Registry, and the National Registry of Causes of Death. In patients calling the national emergency telephone number, a CV related ambulance alarm code was given in 2,541 patients of 3,410 patients (74.5%) resulting in 2,056 of 3,410 primary CV discharge diagnoses (60.3%) with a 30-day and 5-year all-cause mortality of 24.5% and 46.4%, respectively. Stroke, acute heart failure, and ST-segment elevation myocardial infarction (STEMI) carried a 25- to 50-fold adjusted mortality hazard during the first 4 days. In patients with suspected STEMI, 90.5% had an acute angiography performed. Nontransferred, nonreperfused patients with STEMI (9.1%) carried 80% short-term mortality. Noninvasive management of non-ST-segment elevation myocardial infarction was common (37.9%) and associated with an increased adjusted long-term mortality hazard (hazard ratio 4.17 [2.51 to 8.08], p <0.001). Survival in 447 out-of-hospital cardiac arrest patients (13.1%) was 11.6% at 30 days. In conclusion, patients with a CV ambulance alarm call code and a final CV discharge diagnosis constitute most patients handled by EMS with an extremely elevated short-term mortality hazard and a poor long-term prognosis. Although co-morbidities and frailty may influence triage, this study emphasizes the need for an efficient prehospital phase with focus on CV disease and proper triage of patients suitable for invasive evaluation if the outcomes of acute heart disease are to be improved further in the current international context of hospitals merging into highly specialized entities resulting in longer patient transfers.
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Affiliation(s)
- Mikkel Malby Schoos
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark; Department of Cardiology, Køge Hospital, University of Copenhagen, Denmark; Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Maria Sejersten
- Department of Cardiology, Roskilde Hospital, University of Copenhagen, Denmark
| | - Usman Baber
- Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Mette Madsen
- Department of Public Health, University of Copenhagen, Denmark
| | | | - Henning Kelbæk
- Department of Cardiology, Roskilde Hospital, University of Copenhagen, Denmark
| | - Roxana Mehran
- Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, New York
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14
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Claussen PA, Abdelnoor M, Kvakkestad KM, Eritsland J, Halvorsen S. Prevalence of risk factors at presentation and early mortality in patients aged 80 years or older with ST-segment elevation myocardial infarction. Vasc Health Risk Manag 2014; 10:683-9. [PMID: 25525366 PMCID: PMC4266339 DOI: 10.2147/vhrm.s72764] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Elderly patients with ST-segment elevation myocardial infarction (STEMI) are at high risk for complications and early mortality; still, they are underrepresented in clinical trials and observational studies. We studied the risk profiles at presentation and early mortality in elderly (≥80 years) versus younger (<80 years) STEMI patients. Design This was a prospective cohort study. Methods The study population comprised 4,092 consecutive STEMI patients admitted to Oslo University Hospital, Ulleval from 2006 to 2010. Baseline characteristics at admission were recorded, as well as in-hospital mortality. Etiologic strategy was used in the analyses. Results Patients ≥80 years of age (n=536) were more likely to be women and have prior myocardial infarction, angina, and stroke, but were less likely to be current smokers. The crude in-hospital mortality was 16.2% in patients aged 80 years and older versus 3.5% in those younger than 80 years. The adjusted odds ratio for mortality in patients aged 80 years and older versus those younger than 80 years increased with increasing levels of serum creatinine and total cholesterol. In patients with low levels of serum creatinine and total cholesterol, the odds ratio was 3.01 (95% confidence interval, 1.86–4.93; P=0.0001); increasing to 11.72 (95% confidence interval, 5.26–26.3; P=0.001) in patients with high levels. Conclusion High levels of serum cholesterol and creatinine were important risk factors for early mortality in elderly patients. Depending on the levels of cholesterol and creatinine, in-hospital mortality in patients aged 80 years and older varied from a threefold to an almost twelvefold risk compared with younger patients.
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Affiliation(s)
- Peter Andreas Claussen
- Department of Cardiology, Oslo University Hospital, Ullevaal, Norway ; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Michael Abdelnoor
- Centre of Clinical Research: Unit of Epidemiology and Biostatistics, Oslo University Hospital, Ullevaal, Norway
| | - Kristin M Kvakkestad
- Department of Cardiology, Oslo University Hospital, Ullevaal, Norway ; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jan Eritsland
- Department of Cardiology, Oslo University Hospital, Ullevaal, Norway
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital, Ullevaal, Norway
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15
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Showkathali R, Boston-Griffiths E, Parker M, Davies JR, Clesham GJ, Sayer JW, Kelly PA, Aggarwal RK. Should primary percutaneous coronary intervention be the routine reperfusion strategy in octogenarians presenting with ST elevation myocardial infarction? J Cardiovasc Med (Hagerstown) 2014; 15:53-9. [PMID: 24500237 DOI: 10.2459/jcm.0b013e3283649978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM Very few randomized trials have analysed the outcome of primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI) in very elderly patients (≥80 years). An observational study was performed to evaluate the outcome of PPCI in patients of at least 80 years of age who were admitted to our unit. METHODS We included all patients undergoing PPCI in our unit from September 2009 to November 2011. RESULTS Of the 1471 patients who underwent PPCI during the study period, 236 (16%) were at least 80 years of age. The mean age was 85 ± 4 years (range 80-99 years, median 85 years). There was a significant difference in in-hospital mortality [14.4 vs. 2.9%, odds ratio (OR) 5.6, 95% confidence interval (CI) 3.4-9.2, P <0.0001], 30-day mortality (20.3 vs. 4%, OR 6.2, 95% CI 4.0-9.5, P <0.0001), 1-year mortality (28.8 vs. 6.2%, OR 6.1, 95% CI 4.2-8.8, P <0.0001), 30-day stent thrombosis (1.7 vs. 0.4%, OR 4.2, 95% CI 1.1-15.9, P = 0.04) and non-coronary artery bypass grafting major bleed (5.9 vs. 3%, OR 2, 95% CI 1.1-3.8, P = 0.03) between patients aged at least 80 years and those less than 80 years. CONCLUSION The mortality in our patients of at least 80 years was similar to the previously published data, despite the advances in PPCI procedures. Considering the increasing number of octogenarian patients with STEMI at the present time, there is a need for a randomized trial to compare the different treatment strategies for STEMI.
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Affiliation(s)
- Refai Showkathali
- aDepartment of Cardiology, The Essex Cardiothoracic Centre, Essex bAnglia Ruskin University, Chelmsford, UK
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16
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Chanti-Ketterl M, Pathak EB, Andel R, Mortimer JA. Dementia: a barrier to receiving percutaneous coronary intervention for elderly patients with ST-elevated myocardial infarction. Int J Geriatr Psychiatry 2014; 29:906-14. [PMID: 24523068 DOI: 10.1002/gps.4078] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 12/19/2013] [Accepted: 12/20/2013] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Percutaneous coronary intervention (PCI) is the first line of treatment for ST-elevated myocardial infarction (STEMI). This study evaluates the role of dementia in diagnostic cardiac catheterization (to receive PCI) in STEMI patients ≥65 years old admitted to high annual volume PCI hospitals. METHODS Participants were registered in Florida's comprehensive inpatient surveillance system for the years 2006-2007 with principal diagnosis of STEMI. Dementia was defined using ICD-9 codes for presenile, senile, and Alzheimer's type dementia. RESULTS Data from 8331 STEMI patients were used. Of these, 77.2% were catheterized, 67.2% received PCI, and 9.3% had coronary artery bypass graft (CABG). The mean age of the cohort was 76.3 years (SD 7.8 years.); with 43.3% female, 83.4% white, 4.6% black, and 12% Hispanic/other. Of the 248 (3%) patients with dementia, 42% were catheterized. After adjustment for age, gender, and race/ethnicity, patients with dementia were less likely to be catheterized (RR 0.30, 95% CI 0.30-0.50) than non-demented patients. However, among patients who were catheterized, there was no difference in the use of PCI or CABG for patients with versus without dementia (p = 0.56). Of those with dementia, being older and arriving to the hospital in the afternoon were associated with lower likelihood of being catheterized (RR 0.08, 95% CI 0.02-0.28, and RR 0.30, 95% CI 0.10-0.88, respectively). However, having hyperlipidemia increased the probability of catheterization (RR 3.60, 95% CI 1.86-6.98). CONCLUSION ST-elevated myocardial infarction patients with dementia were much less likely to receive diagnostic cardiac catheterization, thereby limiting the possibility for receiving optimal care including PCI or CABG.
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17
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Shan L, Saxena A, McMahon R. A Systematic Review on the Quality of Life Benefits after Percutaneous Coronary Intervention in the Elderly. Cardiology 2014; 129:46-54. [DOI: 10.1159/000360603] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 02/12/2014] [Indexed: 11/19/2022]
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18
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Gao L, Hu X, Liu YQ, Xue Q, Feng QZ. Percutaneous coronary intervention in the elderly with ST-segment elevation myocardial infarction. Clin Interv Aging 2014; 9:1241-6. [PMID: 25114518 PMCID: PMC4124048 DOI: 10.2147/cia.s62642] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
As a result of increased life expectancy, octogenarians constitute an increasing proportion of patients admitted to hospital for ST-segment elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention is currently the treatment of choice for octogenarians presenting with STEMI. The recent literature on this topic has yielded controversial results, even though advances in drug-eluting stents and new types of antithrombotic agents are improving the management of STEMI and postoperative care. In this paper, we review the current status of percutaneous coronary intervention in the elderly with STEMI, including the reasons for their high mortality and morbidity, predictors of mortality, and strategies to improve outcomes.
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Affiliation(s)
- Lei Gao
- Institute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Xin Hu
- Institute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Yu-Qi Liu
- Institute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Qiao Xue
- Institute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Quan-Zhou Feng
- Institute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People’s Republic of China
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19
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Lee KH, Ahn Y, Kim SS, Rhew SH, Jeong YW, Jang SY, Cho JY, Jeong HC, Park KH, Yoon NS, Sim DS, Yoon HJ, Kim KH, Hong YJ, Park HW, Kim JH, Cho JG, Park JC, Jeong MH, Cho MC, Kim CJ, Kim YJ. Characteristics, in-hospital and long-term clinical outcomes of nonagenarian compared with octogenarian acute myocardial infarction patients. J Korean Med Sci 2014; 29:527-35. [PMID: 24753700 PMCID: PMC3991796 DOI: 10.3346/jkms.2014.29.4.527] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 02/10/2014] [Indexed: 11/20/2022] Open
Abstract
We compared clinical characteristics, management, and clinical outcomes of nonagenarian acute myocardial infarction (AMI) patients (n=270, 92.3 ± 2.3 yr old) with octogenarian AMI patients (n=2,145, 83.5 ± 2.7 yr old) enrolled in Korean AMI Registry (KAMIR). Nonagenarians were less likely to have hypertension, diabetes and less likely to be prescribed with beta-blockers, statins, and glycoprotein IIb/IIIa inhibitors compared with octogenarians. Although percutaneous coronary intervention (PCI) was preferred in octogenarians than nonagenarians, the success rate of PCI between the two groups was comparable. In-hospital mortality, the composite of in-hospital adverse outcomes and one year mortality were higher in nonagenarians than in octogenarians. However, the composite of the one year major adverse cardiac events (MACEs) was comparable between the two groups without differences in MI or re-PCI rate. PCI improved 1-yr mortality (adjusted hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.36-0.69, P<0.001) and MACEs (adjusted HR, 0.47; 95% CI, 0.37-0.61, P<0.001) without significant complications both in nonagenarians and octogenarians. In conclusion, nonagenarians had similar 1-yr MACEs rates despite of higher in-hospital and 1-yr mortality compared with octogenarian AMI patients. PCI in nonagenarian AMI patients was associated to better 1-yr clinical outcomes.
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Affiliation(s)
- Ki Hong Lee
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Sung Soo Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Si Hyun Rhew
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Young Wook Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Soo Young Jang
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hae Chang Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Keun-Ho Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Nam Sik Yoon
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Joo Yoon
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyung Wook Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jeong Gwan Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jong Chun Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Myeong-Chan Cho
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Chungju, Korea
| | - Chong Jin Kim
- Department of Cardiovascular Medicine, East West Neo Medical Center, Seoul, Korea
| | - Young Jo Kim
- Department of Cardiovascular Medicine, Yeungnam University Hospital, Daegu, Korea
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20
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Lim SY, Bae EH, Choi JS, Kim CS, Ma SK, Ahn Y, Jeong MH, Kim W, Woo JS, Kim YJ, Cho MC, Kim CJ, Kim SW. Percutaneous coronary intervention for acute myocardial infarction in elderly patients with renal dysfunction: results from the Korea Acute Myocardial Infarction Registry. J Korean Med Sci 2013; 28:1027-33. [PMID: 23853485 PMCID: PMC3708073 DOI: 10.3346/jkms.2013.28.7.1027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 05/03/2013] [Indexed: 12/02/2022] Open
Abstract
This study aimed to evaluate the effects of percutaneous coronary intervention (PCI) on short- and long-term major adverse cardiac events (MACE) in elderly (>75 yr old) acute myocardial infarction (AMI) patients with renal dysfunction. As part of Korea AMI Registry (KAMIR), elderly patients with AMI and renal dysfunction (GFR<60 mL/min) received either medical (n=439) or PCI (n=1,019) therapy. Primary end point was in-hospital death. Secondary end point was MACE during a 1 month and 1 yr follow-up. PCI group showed a significantly lower incidence of in-hospital death (20.0% vs 14.3%, P=0.006). Short-term and long-term MACE rates were higher in medical therapy group (31.9% vs 19.0%; 57.7% vs 31.3%, P<0.001), and this difference was mainly attributed to cardiac death (29.3% vs 17.6%; 51.9% vs 25.0%, P<0.001). MACE-free survival time after adjustment was also higher in PCI group on short-term (hazard ratio, 0.67; confidence interval, 0.45-0.98; P=0.037) and long-term follow-up (hazard ratio, 0.61, confidence interval, 0.45-0.83; P=0.002). In elderly AMI patients with renal dysfunction, PCI therapy yields favorable in-hospital and short-term and long-term MACE-free survival.
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Affiliation(s)
- Sang Yup Lim
- Department of Internal Medicine, Korea University, Ansan, Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Joon Seok Choi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Cardiovascular Research Institute of Chonnam National University, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Cardiovascular Research Institute of Chonnam National University, Gwangju, Korea
| | - Weon Kim
- Department of Internal Medicine, Kyung Hee University, Seoul, Korea
| | - Jong Shin Woo
- Department of Internal Medicine, Kyung Hee University, Seoul, Korea
| | - Young Jo Kim
- Department of Internal Medicine, Yeungnam University, Daegu, Korea
| | - Myeong Chan Cho
- Department of Internal Medicine, Chungbuk National University, Cheongju, Korea
| | - Chong Jin Kim
- Department of Internal Medicine, Kyung Hee University, Seoul, Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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Bergsland J. Major innovations and trends in the medical device sector. Acta Inform Med 2013; 20:44-6. [PMID: 23322954 PMCID: PMC3545326 DOI: 10.5455/aim.2012.20.44-46] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 12/30/2011] [Indexed: 11/20/2022] Open
Abstract
Activities related to medical innovation are accelerating and becoming increasingly important due to the demand for better and less invasive therapies, a rapidly aging population in the developed world and a globally larger population able to afford advanced medical care. Medical Innovation is occurring in the fields of pharmacy, diagnostics and therapeutic imaging, surgical products, interventional procedures and devices. Increasing understanding of basic disease processes further opens the opportunities for innovators. Increased knowledge often cause major paradigm shifts in therapeutic methods.
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Affiliation(s)
- Jacob Bergsland
- The Intervention Centre, Oslo University Hospital, Oslo, Norway ; Institute for Clinical Medicine, University of Oslo, Oslo, Norway ; BH Heart Centre, Tuzla, Bosnia and Herzegovina
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22
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Lazzeri C, Valente S, Chiostri M, Attanà P, Picariello C, Gensini GF. Trends in mortality rates in elderly ST elevation myocardial infarction patients submitted to primary percutaneous coronary intervention: A 7-year single-center experience. Geriatr Gerontol Int 2012; 13:711-7. [DOI: 10.1111/ggi.12005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2012] [Indexed: 12/22/2022]
Affiliation(s)
- Chiara Lazzeri
- Intensive Cardiac Coronary Unit; Heart and Vessel Department; Teaching Hospital Careggi; Florence; Italy
| | - Serafina Valente
- Intensive Cardiac Coronary Unit; Heart and Vessel Department; Teaching Hospital Careggi; Florence; Italy
| | - Marco Chiostri
- Intensive Cardiac Coronary Unit; Heart and Vessel Department; Teaching Hospital Careggi; Florence; Italy
| | - Paola Attanà
- Intensive Cardiac Coronary Unit; Heart and Vessel Department; Teaching Hospital Careggi; Florence; Italy
| | - Claudio Picariello
- Intensive Cardiac Coronary Unit; Heart and Vessel Department; Teaching Hospital Careggi; Florence; Italy
| | - Gian Franco Gensini
- Intensive Cardiac Coronary Unit; Heart and Vessel Department; Teaching Hospital Careggi; Florence; Italy
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Murphy JC, Kozor RA, Figtree G, Hansen PS, Rasmussen HH, Ward MR, Nelson GI, Bhindi R. Procedural and in-patient outcomes in patients aged 80 years or older undergoing contemporary primary percutaneous coronary intervention. EUROINTERVENTION 2012; 8:912-9. [DOI: 10.4244/eijv8i8a140] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
24
|
Renilla A, Barreiro M, Barriales V, Torres F, Alvarez P, Lambert JL. Management and risk factors for mortality in very elderly patients with acute myocardial infarction. Geriatr Gerontol Int 2012; 13:146-51. [DOI: 10.1111/j.1447-0594.2012.00876.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
25
|
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